3261 Hwy 601N (2) DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
~ (Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR f Kenn-A A►,,ce-$0.,DATE {"1., €<'- 74, PERMIT yY
LOCATION i"[3 A� • =f CR�'7 �.fi• �. �(` r: t� f cap F N9 1161
S.R. N0.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ® MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft. .
NO. BEDROOMS NO. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES C90 NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ($' NO ❑
SITE SUITABLE YES ❑ NO ❑ Ccaa`} ��'
SIZE OF TANK '�Ipa gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY Individual Public ❑ ;}
IMPROVEMENTS PERMIT BY I ► , ,C@- INSTALLED BY
CERTIFICATE OF COMPLETION BF �(� _to- Dat.-1.8-?
(8/16/73) *Construction mush comply with all other applicable State and local regulations
LOT AREA ,1, � �y . 'f:t �ft`i� l ` {t u� L
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DAVIE COUNTY HEALTH DEPARTMENT
.� -• (Septic Tank) Improvements Permit.and Certificate of Completion a
(Grougd.Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR :riCtcls, tt' �uwui'f� K�nntrt LAhiCe-$��DATE 4. `• '`� PERMITy C
LOCATI ON, t? �AD r^a,� r. i1. / ' .'+ �Ca Le P l�� 11 V�
-- S.R. NO.
SUBDIVISION NAME LOT, NO. SECTION OR _BLOCK NO.
HOUSE ® MOBILE HOME BUSINESS `❑
House Trailer 800 Gal. 400 Sq. Ft._
NO. BEDROOMS r . . N0. BATHROOMS' . Two Bedroom. House 800 Gal, 600 Sq. Ft.
GARBAGE DISPOSAL UNIT - . YES ❑ NO Rr Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER• YES (2" NO •�❑ Four Bedroom House 1000 Gal. •1200 Sq. Ft.
AUTO. WASH. MACHINE YES' NO ❑
SITE. SUITABLE_ YES i'❑'- -; NO ❑ �w O' .t ►'�t�
SIZE OF TANK gal.
NITRIFICATION FIELD sq- ft. ,
DEPTH OF STONE IN LINES:
WATER.SUPPLY Individual Publid; .-.❑ ".
IMPROVEMENTS PERMIT BY _: . INSTALLED BY '
CERTIFICATE OF COMPLETION . B Dat 13 y
(8/16/73) *Construction must"comply with all.:other applicable; State and local regulations
LOT AREA .'�F.f�: .. '�d¢ �X ' ') v��•
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