274 Riverdale Rd DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements P�rmrt and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR
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SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS [I
House Trailer 800 Gal. . 400,Sq .Ft..
NO. BEDROOMS NO. BATHROOMS Two Bedroom House800Ga1 . 600 Sq. Ft
GARBAGE DISPOSAL UNIT YES [3 NO 70 Three Bedroom House x'00_ Gal-,-> 900 Sq. Ft.
AUTO. DISHWASHER YES va NO )C] Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES NO ❑
SITE SUITABLE { YES ❑ NO ❑ Lr ,� t L*J�z i[ +C 'fi.� �- t fowl '
SIZE OF TANK / gal. t
NITRIFICATION FIELDsq. ft. C
DEPTH OF STONE IN LINES: t
r
WATER SUPPLY: Individual
Public ❑
IMPROVEMENTS PERMIT BY �tC-c. I. ti INSTALLED BY ,,�jf d.0 ��- .% Co
CERTIFICATE OF COMPLETIONBy Date 19'x` 7
(8/16/73) *Construction must co y with all other applicable State and local regulations
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