P541 Daniel Rd �,,. _ •- 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
LOCATION �..�i; ;�`s`�( A � +..�.- _a - _ _ � ;'�.. � - �•.{�'- :;c�.. N9
541
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE IBJ MOBILE HOME BUSINESS ❑
N0. BEDROOMS ar NO. BATHROOMS House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 800,,,Q„al. A019-
AUTO.
-2,L,yF�t.
GARBAGE DISPOSAL UNIT YES ❑ NO Three Bedroom House r;'3l70 Gam. Sq. Ft-",,
DISHWASHER YES [�]` NO ❑ Four Bedroom House "r0�a1. in6 Sq. Ft.
AUTO. WASH. MACHINE YES [ NO ❑
SITE SUITABLE c YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD f�V sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual [ Public
IMPROVEMENTS PERMIT BY . ;,�- ;► r INSTALLED BY'.pa
CERTIFICATE OF COMPLETION BY A Date 9 �s
(8/16/73) *Construction must comply with all o he applicable State and local regulations
LOT AREA :t o v p, 'dr=•�
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