P732 Mill St z DAVIE COUNTY-HEALTH DEPARTMENT
(Septic Tank),Improvements Permit and Certificate of Completion T _
(Ground Absorption Sewage Disposal System,- G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR--., �,c.r- DATE 9
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LOCATION �, s `. '1 -. f� NO 732
�t• : Vii. :� / 0 f4o.', 4. e.., S.R. NO. / F4_/d
SUB6IVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE Q MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
N0. B DROOMS N0. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO Three Bedroom House 900�G 1. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO Four Bedroom House 1000 Gal q, 't.
AUTO. WASH. MACHINE YES ❑ NO
SITE SUITABLE YES [3 NO 2er � -,�t s46/ , 1.3 r.
,*
SIZE OF TANK d gals/' NCY�P
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: o?fT 0Ne S /'p i>
WATER SUPPLY: Individual., Public ❑ ,.� � z -C
IMPROVEMENTS PERMIT BY f 6i't,LGr INSTALLED BY & cz Ap
CERTIFICATE OF COMPLETION
BY Date =;Z6
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(8/16/73) *Construction must comp with all other app cable State and local reg ula n ns
LOT AREA
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