295 Miller Rd DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
.. (Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
PP"OPWNER OR CONTRACTOR �`; i`,, . .r ,"r's,�r DATE ,''-" / PERMIT
LOCATION ' 1�i�. �1 �� �.. ,.e �si z.� J '!, j4. N9 1374 4
S.R. NO.
SUBDIVISION NAME LOT NO.. SECTION OR BLOCK NO.
HOUSE MOBILE HOME E3 BUSINESS ❑
'? House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS ^' NO. BATHROOMS 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 ❑ `�` 1 ,.:. s- -t.�, +J�, ?. �,
SITE SUITABLE YES [] NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD (,vu sq. ft.
DEPTH OF STONE IN LINES: /pee
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY"- '�'G..°f 41''`�'��w<<: INSTALLED BY A vi t r T, e"o s
CERTIFICATE OF COMPLETION
gy � i'Y�4t,,,.�.J Date �
(8/16/73) *Construction must cc6ply with all other applicable State and local egulations
LOT AREA
{
J t
1
•.t
i
}