P101 Main Church Rd DAVIE COUNTY HEALTH DEPARTMENT
- (Septic Tank) Improvements;Permit and`CCertificdte`of-Completion
(Ground'Absorption Sewage Disposal System G. ha'paer 130 Qrfticle 13C)
OWNER OR CONTRACTOR x}11 -if-"' Z stn „DATE. .- ' T • PERMLT�.wa
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LOCATION � ; U tr :
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SUBDIVISION NAME.' LOT NO. SECTION OR BLOCK NO.
HOUSE ❑:; MOBILE HOME BUSINESS, 0
House Trailer 400 Sq. Ft.
NO. BEDROOMS NO. BATHROOMS
Two Bedroom House 8000
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 gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: G
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY -,. �`►NO,,AA, INSTALLED"BY
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CERTIFICATE OF COMPLETION
By Date=
(8/16/73) *Construction mus comply with'a`� of er applicable State and local^ a ul' t ons
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