134 Apache Rd ~ DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorp ion Sewage�isposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR aj . . � � DATE 5 ZS'-74 PERMIT
LOCATION I37 17AC/� W N9 992
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME E3 BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS _ NO. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft. . .-
GARBAGE
t. ._GARBAGE DISPOSAL UNIT YES P!I',,NO ❑ Three Bedroom House 900 Gal. 900 Sq: Ft.
AUTO. DISHWASHER YES aRoo�-NO ❑ Four Bedroom House 1000 Gala 1200 Sq. Ft.
AUTO. WASH. MACHINE YES 93r,','ANO ❑ IWT r 14 -
SITE SUITABLE YES C2 NO ❑ _
SIZE OF TANK 'V gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: !f
WATER SUPPLY: IndividualP blic ❑ 11��n� '� _
IMPROVEMENTS PERMIT BY '' _INSTALLED BY
CERTIFICATE OF COMPLETION By Date b• 1 to-72
(8/16/73)-" *Construction must co ply with all other applicable State and / �local regulations
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