234 Jack Booe Rd (2) DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absor tion Sewn a Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR �� s. s3 _ DATE I"" .. PERMIT
LOCATION N? 1256
S.R. NO. -e3ri
SUBDIVISION NAME r LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME EM BUSINESS ❑
.,.� House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS NO. BATHROOMS � Two Bedroom House 800Q. 600 Sic . Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House �Rh-do ==zz:,
AUTO. DISHWASHER YES Oa'--NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES @"' NO ❑ +$ �0.0 f + f C
SITE SUITABLE YES ❑ NO ❑ p / ��,,,, 6
SIZE OF TANK O gal. f �c.+�J �, . , t
// Gam" * +1
NITRIFICATION FIELD /„ (� sq. ft. j� ' `',".S '' 1 s `�c t elk r-
4 _„��
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY / a?. f INSTALLED BY iPc 'fi7'10 :9. "'r'�'»:�e
CERTIFICATE OF COMPLETION
By < Date1--��—
(8/16/73) *Construction must comply th all other applicable State and local regulations
LOT AREA /0 i��.Y'+e.,'�`
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1 4: X
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