Jesse King Road • " �'- 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 l ;_ :/ .. , �, �t DATE . , PERMIT
LOCATION N9 658
S R NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME E3 BUSINESS ❑
House Trailer 800 Gal. 400 Sq , Ft.
N0. BEDROOMS . _ N0. BATHROOMS Two Bedroom House f $OOµGat-,� -jr00 .Sq Ft.
GARBAGE DISPOSAL UNIT YES 13 NO 1:3 Three Bedroom House Q4900'Gi-l- 9OO Sq:—t t
AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft'.
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZEOF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF. STONE _IN LINES:
WATER SUPPLY: Individual � Public ❑
IMPROVEMENTS PERMIT BY 4. «'�, : °'. INSTALLED BYFA L S 1 `
CERTIFICATE OF COMPLETION BY "�
Date f 2-
(8/16/73) *Construction must c ply with all other applicable State and local regulations
LOT AREA ,,