1975 Hwy 158 (2) 1
DAVIE COUNTY HEALTH DEPARTMENT
r
t (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR r,.s\r•f ':�v'. t�':> � DATE : ' - L. PERMIT
LOCATION 1�u. �_ , , - N? 1023
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME 0 BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
N0. BEDROOMS . N0. 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 qTD gala
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: :; a �� ,�c! �✓"�r .
WATER SUPPLY: Individual ❑ Public
IMPROVEMENTS PERMIT BY �:k. Y*V1 INSTALLED BY r
CERTIFICATE OF COMPLETION By rnp,_� Date
(8/16/73) *Construction must compqy with all other applicable State and local regulations
LOT AREA
Cw �1 ta� - v
Vi� 4
. ...•�,i`�t.f
7