P12 Merrells Lake Rd 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 ::�4 DATE ;PERMIT
No
LOCATION 12
IS'r t� c' f t+ ��,5 1 Gig: ?. - '
- -- - - - S.R. N0.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE,. HOME - BUSINESS ❑
NO. BEDROOMS NO. BATHROOMS` House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 800 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 e-2 _ gal.
NITRIFICATION FIELD rj r-70 sq. ft.
r
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY �' . i j,�J, �� .�z INSTALLED BY
CERTIFICATE ,OF COMPLETION By l Date -07 a_ 9-f--
(8/16/73)
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(8/16/73) *Construction must com with all other applicable State and local regulations
LOT AREA
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