2103 Milling Rd (2) ' DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank),IMprovements Permit and Certificate of Completion
-,.:. (dround Absorpt�oiilftwage DisposabSystem - G.S. Chapter 130-A ticle 13C)
OWNER OR CONTRACTOR �� '�� ' r `- .�"':�' DATE �� % PERMIT
1414
LOCATION
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
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HOUSE MOBILE HOME 0 BUSINESS ❑
r /. House Trailer 800 Gala 400 Sq. Ft.
NO. BEDROOMS � J N0. BATHROOMS / L Two Bedroom House 8 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES E,�NO < Three Bedroom House '� -OQ,, 900 Sq. Ft.
AUTO. DISHWASHER YES � 0 �] urBed-rooms,
Fo - oom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES [3 NO ❑ 'r A c, ; 4 �f'/�'.L, ..-C? 14 f'1,
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK _ 4
gal.1. ,�i , �i; 1 ca :VC
NITRIFICATION FIELD j' ° sq. ft.
DEPTH .OF STONE IN LINES;
WATER SUPPLY: Individual s _ Public ❑
IMPROVEMENTS PERMIT BY I INSTALLED BY
CERTIFICATE OF COMPLETION By � Date �' �°?-77
(8/16/73) *Construction must comply Vdith all other applicable State and local regulations
LOT AREA
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PHONE 765-1113
ROGERS Buitcling 6o,n.#any
GENERAL CONTRACTOR
550 HEARTHSIDE DRIVE
WINSTON-SALEM, N. C. 27104
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