411 Liberty Church Rd (2) DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground"Absorpt' n Sewage Disposal System - G.S. •Chapter• 130-Articl"3C)
OWNER OR CONTRACTOR _ ' DATE ,.. PERMIT
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LOCATIONe,44# ..._. !/ µ 1\ 962
LIZ I S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOMEM BUSINESS ❑
« House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS + NO, BATHROOMS _ Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES El NO Three Bedroom House a 900 Sq. Ft.
AUTO. DISHWASHER YES C3 No
[ Four Bedroom House 1200 Sq. Ft.
AUTO. WASH. MACHINE YES WO 'NO ❑
SITE SUITABLE YES [3 NO , ` +" at ,.4
SIZE,OF TANK An, gal.
NITRIFICATION FIELD sq. ft.
414?ve
1t
"DEPTH OF STONE .IN LINES:
WATER .SUPPLY: Individual " Public ❑
...,ate
IMPROVEMENTS PERMIT BY J INSTALLED BY + ..
CERTIFICATE OF COMPLETION ByDate
(8/16/73) *Construction must com ly with all other applicable State and local regulations
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LOT AREA"C;,'et!'&.* ).4,0 Gaal CLW� 94j
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