P1221 Riverview Rd r 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 DATE = PERMIT
LOCATION ; ,-. .' . y: , C, s 1\ 12 21
S.R. N 0.
SUBDIVISION NAMELOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
-^ �,« '.% ' 1 House Trailer 800 „Ga„ „4.Q.Q,,Sg,..,,Ft�
NO. BEDROOMS <r NO. BATHROOMS r"'" '"""
Two Bedroom House , $QO Gab LGQQ_5q.._Ft:r
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ 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 gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY INSTALLED BY ,CERTIFICATE OF OF COMPLETION By Date
(8/16/73) *Construction must cWmply with all other applicable State and local regulations
LOT AREA
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