905 Williams Rd DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
-(Ground Absorption Se wa Disposal System - G.S. Chapter' 130-Article 13C)
OWNER .OR CONTRACTOR �1ar-C+ �a�4 x-� DATE -7 — PERMIT
LOCATION1�'�c►ties i � tit"ate C` Ciao Crrt ' �' �'tr.� lr �b.a4 ' � N° 1327
^t t c.sA ►! - �. c++. f -- S.R. NO. A610
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS 2 NO. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES 2❑ NO ❑ Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ INO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑ ho + Tkoc
SIZE OF TANK gal. r ' vc
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY YVNCV J to INSTALLED BY
CERTIFICATE OF COMPLETIONBy ' L�, �^ Date 17 -/a -7 7
(8/16/73) *Construction must c mply with all other applicable State and local regulations
LOT AREA
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