202 Williams 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 +-;. ;s.. +'3'�+ ;- DATE _ ;, , "fa PERMIT
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LOCATION lr .° 532
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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 890 CTal, 60Q- q,_ Vit.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House r:QOM OO,,Sq,.•Ftp
AUTO. DISHWASHER YES, ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.,
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ N ❑ r
SIZE OF TANK C1,� gal.
NITRIFICATION FIELD C3- sq. ft.
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DEPTH OF STONE IN LINES:.
WATER SUPPLY: Individual E Public ❑ _ c
IMPROVEMENTS PERMIT BY ��\� -•r <:f�'`�• S ':o�tr ^-+t....
INSTALLED BY
CERTIFICATE OF COMPLETION
By , t: �J��,..� Date
(8/16/73) *Construction must cbmptf with all other applicable State and local `regulations
LOT AREA
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