177 Boger Rd - DAVIE COUNTY- HEALTH DEPARTMENT
�,611
(Septic Tank) Improvements Permit and Certificate of Com letionA�
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR -I o 4A AN l e / Mc Tyo Y DATE 7— 2--79— PERMIT r
LOCATION 1 /S—� Lc- L , a.v G ey �ut` /Pc� _ /x-38 N? ( 0 1
a -ff cc re b.✓ 1 X, S.R.—NO. /438
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 ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY INSTALLED BY
CERTIFICATE OF COMPLETION By Date — Z _ 7
(8/16/73) *Construction must comply with all her pplicable State and local regulations
LOT AREA
0 ,
A
f `� 3 �