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DAVIE COUNTY HEALTH DEPARTMENT
(Septic .Tank) Improvements Permit, and Certificate of Completion
Ground,Absorption sewage Dis oaal' S t� ,G.,S
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OWNER 0 OONTRAGTOR:_�;x�+5'"�r���% ,"�.�'/nfa,T ,� / DATE ~J{ ,/r.'�7;' PET
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LOCATION ,, . ,C- i 7'' {� J/il�fo74� /, lr 0 1954 .
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME Ej BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
N0. BEDROOMS _ N0. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES [3 [3NO
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SIZE OF TANK al.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: e7-
WATER SUPPLY: Individual Pu lic [� /(
IMPROVEMENTS PERMIT BY INSTALLED BY
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CERTIFICATE OF COMPLETION
B Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
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' DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion _
(Ground Absorption Sewage Dis.11 posal System - G.S. Chapter 130 Articls?1
OWNER OR CONTRACTOR _F' ;r�- „✓i �ix';� ,:��'. i'.1 r' /f DATE ,' ;� /.'`r -='� PERMIT
LOCATION _�i°�� !" ; r,��.�, rr: '`}'" f" ,f� i' lr�. 1954
✓' S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME Ej BUSINESS ❑
House Trailer 800 Gal. 400 Sq Ft.
N0. BEDROOMS N0. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ _ Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual 0- Pu t 11c ❑ �,
IMPROVEMENTS PERMIT BY INSTALLED B� /
CERTIFICATE OF COMPLETION - Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT ..AREA
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