P933 Clark Rd DAVIE COUNTY HEALTH DEPARTMENT
- - ,(Septic-Tank) Improvements„Permit and Certificate of Completion
(Gound Absor ti�+on Sewage,Dis osa.J , S stem,.;,G.S.,. Chapter 130=Article: l3C)
OWNER; OR• CONTRACTOR *J PA 0 S.-Q . �E' Qk "DATE' +,• (� +►`''� P T'”
LOCATION An j,
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+ LO tA it S.R. NW .
SUBDIVISION NAME LOT NO.; SECTION OR BLOCK NO.,
HOUSE MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq Ft.' ,"
NO. BEDROOMS' NO. BATHROOMS
Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO 500 Three Bedroom -House 900 Gal. 900 Sq. Ft.
AUTO.. DISHWASHER" YES ❑ : NO Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. 'WASH. MACHINE YES N0 ❑
SITE SUITABLE YES [2.°"!NO•, [3
_r SIZE' OF TANK gal. .
NITRIFICATION FIELD +� "Jf C""+ sq. ft.
j
DEPTH OF STONE` IN LINES:- f 7 .lt;
:WATER SUPPLY:' IndividuaPublic
IMPROVEMENTS PERMIT BY INSTALLED BY ,: ,
CERTIFICATE OF COMPLETION
By ` ln Date
(8/16/73) "..*Construction .must c mply with all `'other applicable .State and local regulations.
LOT. AREA`
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