5930 Hwy 801S (2) • DAVIE COUNTY HEALTH DEPARTMENT 5q`�� oC S,
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR DATE ?.t !. "�, y PERMIT
LOCATION �!i r ^ r�' 'L' t �.. a:. . . �.j. rw ':r . :�;. �, ,-r'r=� �, rN ND 522
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer 80011.. 400 S Ft.
NO. BEDROOMS NO. BATHROOMS Two Bedroom House r--TO Gal00 S Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House 9900 Tal —900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House ' 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE . YES ❑ NO ❑
SITE SUITABLE c YES ❑ NO ❑ �t>
SIZE OF TANK 1 ' ) gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: jo
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY - n INSTALLED BY if /• {-�'r'•�}_�L,,^.tj
CERTIFICATE OF COMPLETION By N Date Al 71 0—
(8%16/73) *Construction must com with all other applicable State and local regulations
LOT AREA