P867 Riverview Rd 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 Tl,^, ,t_- c ^ DATE '` -t ) `7 PERMIT
LOCATION1�,�# `!, P,. :j i+ 'r 01 -f». 1 . t � :.' . i y1'i'Z ) +i q N? 867
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SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS ❑
House Trailer 800 Gala 400 Sq. Ft.
N0. BEDROOMS NO. BATHROOMS Two Bedroom House 800 Gal. 600-Sq- Ft.
GARBAGE DISPOSAL UNIT YES El NO NO . Three Bedroom House 900-Gam Ft
AUTO. DISHWASHER YES 5;�'` NO ❑ Four Bedroom House UOU"Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES Com' NO ❑
SITE SUITABLE p YES NO ❑ t?c'�r�` r�-= J ' rt' r uc
SIZE OF TANK l gal. `v:� .
NITRIFICATION FIELD . sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑ n
IMPROVEMENTS PERMIT BY �``.,-r. `ti r, T:.r 1 INSTALLED BY
CERTIFICATE OF COMPLETION By Date -�9
(8/16/73) *Construction must c mply with all other applicable State and local regulations
LOT AREA
LIP 4.
A