P1767AMW 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 DATE / ; -' PERMIT C
LOCATION/,; lr 9 1767 Ury
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE p MOBILE HOME U 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 _ _ _ �_ 1•'__ _
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
INSTALLED BY G / �''
CERTIFICATE OF COMPLETION By ip F (,/ 7 T �- �- Date L� 1,2 f/7
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA