P995DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground -Absorption Sewage
Disposal
System G.S. Chapter 130 -Article 13C)
OWNER ,.bR.,60NTRACTOR.
DATE
PERMIT
995
LOCATION
S.R.
NO.
SUBDIVISION NAME
LOT NO. SECTION
OR
BLOCK NO.
HOUSE 0 MOBILE HOME
t3
BUSINESS
0
House Trailer
800
Gal. 400
Sq. Ft.
NO. BEDROOMS NO.
BATHROOMS
Two Bedroom House
800
Gal. 600
Sq. Ft.
GARBAGE DISPOSAL UNIT YES
El
NO 0
-Three Bedroom House
900
Gal. 900
Sq. Ft.
AUTO. DISHWASHER YES
❑
NO ❑
Four Bedroom House
10.00
Gal. 1200
Sq. Ft.
AUTO. WASH. MACHINE YES
0
NO
SITE SUITABLE YES
0� 'NO
❑
SIZE OF TANK 't) gal.
NITRIFICATION FIELD
sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual-,❑ Public [3
IMPROVEMENTS PERMIT BY
INSTALLED BY -?Oj (,UV01",Q,
CERTIFICATE OF COMPLETION By 2) 41-1 P - Q. ()-V,, L-\
Date -', -
- 1
(8/16/73) *Construction must comply with0aill. other applicable State and local regulations
LOT AREA
V