127 Liberty Church Rd 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. `• '`� PERMIT y 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
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