470 Elmore 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 CONTRACTORDATE ; '? 77 PERMIT
LOCATION (%'m7<<t:i �.,. t.r - `��; C(„'t>, _ Gji} -{,i `t13 �� 1342
7E "e + S.R. N0. r 2
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS ❑
;� House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS :• NO. BATHROOMS -2- Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES Er NO ❑ Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ga- NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES Qr NO ❑ :>s,f{,.� 140C tir,,�
SITE SUITABLE YES 0'— NO ❑
SIZE OF TANK /9.0 gal. ;; ,,
NITRIFICATION FIELD sq. ft. `�'� ,?°�+ A%
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public Q
IMPROVEMENTS PERMIT BYINSTALLED BY
CERTIFICATE OF COMPLETION i;; _ ,, , L' f:,�' 7 �'' 1/-
By Date
(8/16/73) *Construction muse comply with all other applicable State and local regulations R
LOT AREA
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