P495 No Creek Rd DAVIE COUNTY HEALTH DEPARTMENT
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(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absor tion Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR /�'� c:-3� DATE "� " yA ^ 1.1! PERMIT
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LOCATION i'C_ (''i ?.:.�►t`� 1 �,� 7�ri'r .e. �, /��^4'�. lr 495
�u S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ` k MOBILE HOME BUSINESS ❑
.House Trailer 400
NO. BEDROOMS _ NO. BATHROOMS t Two Bedroom House _ al
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO r Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES tf NO ❑
SITE SUITABLE YES NO ❑ C7 j e •� I �t /�, .x 5!�rV
SIZE OF TANK gal:
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NITRIFICATION FIELD 400 sq. ft. „�.. },
DEPTH OF STONE IN LINES: %: ,�, s � 43 ��os / � � � 3 X
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY j i Q!- INSTALLED BY
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CERTIFICATE OF COMPLETION By Olt
(8/16/73) *Construction must comply fKth all other applicable State and local regulations
LOT AREA f e q �.
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