P1490 CooleemeeDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter.130-Article 13C)
OWNER OR CONTRACTOR a I.YPirm�„ DATE -4/2d 77 PERMIT
LOCATION _ N vi -d r IA n . C- l l l /I A ,- "A 4--9k 4�' N? 1490
S.R. N 0.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME 0 BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS NO. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑ GtcJtx�c,ay�
SIZE OF TANKgal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public
❑ _
IMPROVEMENTS PERMIT BY l��i-[/ INSTALLED BY
CERTIFICATE OF COMPLETION
By� — Date
(8/16/73) *Construction must comply with all other applicable State and local re ulations
LOT AREA i
1
DAVIE COUNTY HEALTH DEPARTMENT
s (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter,130-Article 13C)
OWNER OR CONTRACTOR�v, f DATE PERMIT
LOCATION
1\ 9. 1490
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME ❑ BUSINESS
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLEp YES ❑ NO ❑
SIZE OF TANK b �%� gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY�:'z.%tom
House Trailer
800
Gal.
400
Sq.
Ft.
Two Bedroom House
800
Gal.
600
Sq.
Ft.
Three Bedroom House
900
Gal.
900
Sq.
Ft.
Four Bedroom House
1000
Gal.
1200
Sq.
Ft.
INSTALLED BY,&Litt. � "r %��,�.
CERTIFICATE OF COMPLETION �'
�..t. ,.�;%.:..G' Date—
(8/16/73), *Construction must comply with all other applicable State and local r
LOT AREA
N
lations
DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter;130-Article 13C)
OWNER OR CONTRACTOR ;,, Pin„�_� DATE 4^' PERMIT
LOCATION /'�/ ��� lr 1490
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME ❑ BUSINESS ❑
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY
House Trailer
800
Gal.
400
Sq.
Ft.
Two Bedroom House
800
Gal.
600
Sq.
Ft.
Three Bedroom House
900
Gal.
900
Sq.
Ft.
Four Bedroom House
1000
Gal.
1200
Sq.
Ft.
J
t
INSTALLED BY,'�;x!.�
CERTIFICATE OF COMPLETION ,',.`1 i 1/
(8/16/73)
LOT AREA
By , . E - Date ��`—'
*Construction must comply with alk other applicable State and local regulations
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