499 Griffith Rd DAVIE COUNTY HEALTH DEPARTMENT
' (§eptic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal-System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR _.,I /.M iw %-o 4"Me V'14AA A DATE PERMIT
LOCATION `�4 r� iry 0#V '` t U . 604
of tt:44 4 4,,,j /.4 4n E+ r,/• s � r o S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS ❑
3�a"' House Trailer 800 Gal. 400 Sq. Ft.
N0. BEDROOMS _ NO. BATHROOMS Two Bedroom House 800 Gala 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES &-oNO 13Four-Bedroom House ' 1000 Gala 1200 Sq. Ft.
AUTO. WASH. MACHINE YES be NO ❑
SITE SUITABLE YES �NO ❑, i �.
SIZE OF TANK ..✓ L gal. 'nr . S; j� + ' )c
NITRIFICATION FIELD sq. ft.
eta �
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual 20— Public ❑
IMPROVEMENTS PERMIT BY&aj& INSTALLED BY
CERTIFICATE OF COMPLETION.
By. Date
(8/16/73) *Construction must comply with all of er jppli.cable State and. local regulations
LOT AREA f-3 45 CL