182 Hill Top Dr DAVIE COUNTY HEALTH DEPARTMENT lop b L`
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(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
% OWNER OR CONTRACTOR C?�:�; ,-,, ` x c e ,t DATE !/ f l 7 PERMIT
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LOCATION q_ ,, ,` - j� t i r *d /:i� �^ 1384
--%j r.% I{ P-j i,8,> 1;,,,•: ,i s. ..� - ���,.;. 63 C--,-A a-4 9+- S.R. NO. 161y-
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 ❑ 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 ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK G ga 1.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: � Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY T4 '(Y"�t,�,, +G INSTALLED BY '`2z .l'
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CERTIFICATE OF COMPLETION
BY — Daterz
(8/16/73) *Construction mus comply wi h al ther applicable State and loca eg dons
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