P977 Madison Rd COUNTY HEALTH DEPARTMENT No w /Y`Ad i S dA/Y
(S ptic Tank) hnprovements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR PERMIT
LOCATION N9 977
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS ❑
t House Trailer 800 Gal. 400 Sq. Ft.
NO. BE RdOMS � �_` NO. BATHROOMS Two Bedroom House 800 Gal. 600S4. Ft
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House 900 Gal. �b0'Sq Ft,,,
AUTO. DISHWASHER YES ❑ NO Q Four Bedroom House l)•O GaT" X1200 Sq Ft.
AUTO. WASH. MACHINE YES ❑ N0 ❑ r,�Y1�� . +'� ,`i4 �.
SITE SUITABLE YES ❑ NO ❑ i-" /
� ems' - .-?,.
SIZE OF TANK d gal.
NITRIFICATION FIELD O sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY ,_ /::t .: INSTALLED BY `b a J"
CERTIFICATE OF COMPLETION ,By Date ' tf
(8/16/73) *Construction must c,66ply.with all other applicable State and local regulations
LOT AREA
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