123 Prison Camp Rd DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements hermit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR VVR+h e,,Qnlin>cr I-�'�ah =�a., :�T. DATE PERMIT
LOCATION cv _ - _ N9 556
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S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME 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 ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK /awn gal.
NITRIFICATION FIELD o fl sq. ft.
DEPTH OF STONE IN LINES: /a"�
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY INSTALLED BY
CERTIFICATE OF COMPLETION Y� �c�
BY Date
(8/16/73) *Construction must Amply with all other applicable State and local regulations
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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 CONTRACTOR 1Vpnf {� �nAnli;.�rr ',jh ,+a._ -Dc.Ts DATE PERMIT
LOCATION Ce j,,-T%4 t r,:S, t_1 �:.-�- - N? 556
�r"-'n'- Pn .,1 Jae„+eq- S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME E3 BUSINESS CM
House Trailer 800 Gal. 400 Sq. Ft.
NO. 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 ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO.. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK 1 gal.
NITRIFICATION FIELD AO-0 sq. ft.
DEPTH OF STONE IN LINES: /a
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY INSTALLED BY .r..-.,
CERTIFICATE OF COMPLETION
Y1r'ti Date 73'..
(8/16/73) *Construction must mply with all other applicable State and local regulations
LOT AREA
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