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P682 Gun Club 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 ;i DATE ' -? "; PERMIT r, N° c� LOCATION "f r" ,:'',,{ +: -` ,',:, / ! 1:'. . ',. ;� - r ,,, �f , ... 682 S.R. NO. SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO. HOUSE ❑ MOBILE HOME BUSINESS ❑ House Trailer. 800 Gal. 400 Sq. Ft. N0. 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 ❑ 17,4 4_t4r,", ta•/c.*+t SITE SUITABLE YES ❑ NO ❑ SIZE OF TANK gals ?., • ' .w:�c� -dc. NITRIFICATION FIELD sq. ft. DEPTH OF STONE IN LINES: WATER SUPPLY: Individual ©'f Public ❑ IMPROVEMENTS PERMIT BY ` ` ,tic. ;L; ,_-`0 i', INSTALLED BY -T S,? fn l r CERTIFICATE OF COMPLETION By �u.v.t .� Date (8/16/73) *Construction must Womply with all other applicable State and local regulations LOT AREA 'V If P Vy