401 Davie Academy Rd (2) 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 CONTRACTORi11 t'?'Nf_*,L DATE �3flaf77 PERMIT /� p
LOCATION lsJs: 11f, j�;L. {�fJ43ncF l.t{ r,�c. Yil'1 l4�**:+t.,�1���' �Aat i�'. 1.�'j,• �`��' 13`20
S.R. N0,
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS ❑
j/ House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS . NO. BATHROOMS 114" Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT . YES ❑ NO [R' Three Bedroom,House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES Q. NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES NO ❑
SITE SUITABLE YES [$' NO ❑
SIZE OF TANK C* gal.
NITRIFICATION FIELD /1016 sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Publics cd
IMPROVEMENTS PERMIT BY -- t't1' INSTALLED BY
CERTIFICATE OF COMPLETION By M,.�� Date
(8/16/73) *Construction must comply with all. other applicable State and local regulations
LOT AREA ' �x�d!t '
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