P490 Country Ln DAVIE COUNTY HEALTH DEPARTMENT
(Septic"Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Articje 13C)
OWNER OR CONTRACTOR r Gfti .!it DATE EA,~t --jD —75 PERMIT
TCATIONlilN• 490
S.R. NO.
SU DIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME E3 BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BE ROOMS NO. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three .Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES NO ❑ f p
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD ) sq. ft. c ! `��� Glx C� 1/joc
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑ /JQ%J- /�
IMPROVEMENTS PERMIT BY INSTALLED BY
CERTIFICATE OF COMPLETION By Date "J)
(8/16/73) *Construction must omp with all other applicable State and local regulations
LOT AREA
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DAVIE COUNTY HEALTH.DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absor tion Sewage Disposal System - G.S. Chapter 130-ArtiSle 13C)
OWNER OR CONTRACTOR DATE 6 �- M ''� �- �l PERMIT
490
LOCATION
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BE ROOMS NO. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES Q. NO ❑ Four .Bedroom House 1000 Gal. 1200 Sq. Ft. `
AUTO. WASH. MACHINE YES `1. NO ❑ / ,
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal. i
NITRIFICATION FIELD c).? sq. ft.
DEPTH OF STONE IN LINES: j�f'
WATER SUPPLY: Individual public ❑ r
IMPROVEMENTS PERMIT BY fh / -' - INSTALLED BY
CERTIFICATE OF COMPLETIONPIS
BY i ,/ Date
t
(8/16/73) *Construction must comp with all other applicable State and local regulations
LOT AREA
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