179 Riverview 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 lgee /; rr- „ # DATE f.-,?s_ 1}y=-PERMIT
LOCATION 45� 0 N? 41
twrS.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
-NO. BEDROOMS G: NO. BATHROOMS Two Bedroom House 800 Gal. 00 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 [aOO” NO ❑
SIZE' OF TANK gal.
NITRIFICATION FIELD -m sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BYINSTALLED BY `✓Q�J�-1 j / R
CERTIFICATE OF COMPLETION �
By Date,-
(8/16/73) *Construction must co y with all other applicable State and local regulations
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DAVIE COUNTY: HEALTH DEPARTMENT
` (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Ab.soz tion Sewage -Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR _j L�ttc7 c .r t. ,r3 e'-e a. DATE /- w.. ,. t} +PERMIT
LOCATION �� A - i 'y`;,/p'; t�yr : lTt��'l •'r ', NY 41
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
Ile
+' HOUSE ❑ MOBILE HOME BUSINESS ❑
NO. BEDROOMS s� N0. BATHROOMS House�rTxa ler 8 q: t.
Two Bedroom House w,�00RGal. . O 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 j!.,) 0 gal.,
NITRIFICATION FIELD 0 (3 sq. ft.
DEPTH OF STONE IN LINES: '.:.
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY ��' ,`*r_, �..+?.�.•r.C�Q.s. INSTALLED BY l,�e -C d x,
CERTIFICATE OF COMPLETION �"o� ~r/
By Date o
(8/16/73) *Construction must co y with all other applicable State and local regulations
LOT- AREA
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