416, 441 Jack Booe Rd DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorptiioon Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR .I C Lr e /g,r d DATE — = PERMIT
N°
LOCATION Q c= (�c� �� �, 31
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME Eff 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 :6Z gal.
NITRIFICATION FIELDp sq. ft. ,
DEPTH OF STONE IN LINES: 1,4.4i4l
WATER SUPPLY: Individual ❑ Public ❑ w
IMPROVEMENTS PERMIT BY Yf INSTALLED BY6Lf
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CERTIFICATE OF COMPLETION By j Date
(8/16/73) *Construction must compf4 with all other applicable State and local regulations
LOT AREA
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