P123 Todd Rd 4-
j DAVIE COUNTY HEALTH DEPARTMENT _ �ro�e/( koWA•
(Septic Tank) Improvements Permit and Certificate of-;Completion <.;
(Ground Absorption Sewage'b `'sposal System - G.S. Chapter 130-Article'�13C)
TRACTOR . ' e—. 5,t-a, �:s -j DATE ��.-�t�- 7J4 PERMIT
M 123
OWNER OR CON : ,
LOCATION ice;t'. 3. A�►t�A E...'�-t-cm C- QJ, 11,o') I U 616( l�lit�
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 S . Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO Three Bedroom HouseqO=OOGal.
900 Sq. Ft
AUTO. DISHWASHER YES ❑ NO Four Bedroom HouseK 10 q. Ft.
AUTO. WASH. MACHINE YESNO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE: OF TANK iar-o gal.
NITRIFICATION FIELD G sq. ft.
DEPTH OF STONE IN LINES: �•
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY E - INSTALLED BY ) rc 41 C,
CERTIFICATE OF COMPLETIONBY Date i _j0-7gG
(8/16/73) *Construction must mply with all other applicable State and local regulations
LOT AREA
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