CooleemeeDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground..Absorption Sewage Disposal System - G.S. Chapter 130 -Article
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OWNER OR CONTRACTOR DATE PERMIT
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LOCATIO�j l� r'�;'�-7 Z'" t' - �'p t'�. r /�t�7�1`;f".:,, . ,,'�r,' y;r f ? 1794
SUBDIVISION NAME LOT NO.
HOUSE B— 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 _9ep gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY
S. R. NO.
SECTION OR BLOCK NO.
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 �y1z'a ar+i
CERTIFICATE OF COMPLETION i ,.'
By t Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
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