P684DAVIE 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 "" DATE PERMIT p
LOCATION ; ' N� 684
4
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOME El 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 9,0�
gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY
House Trailer 800w, 400 Sq.,_. Ft.
Two Bedroom House -800 Gal) ,'600 Sq. Ft>
Three Bedroom House 900 Gal. 0 SFt.
q.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
INSTALLED BY
t
CERTIFICATE OF COMPLETION By Jr-YN0.M Date 7'1-9- � 7
(8/16/73) *Construction must c ply with all other applicable State and local regulations
LOT AREA
/4�