1903 Milling Rd DAVIE COUNTY HEALTH DEPARTMENT
Y (Septic Tank) Improvements Permit and Certificate of Completion
' (Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR ~,�, C' „ ..;a r DATE : //-/ PERMIT
LOCATION _ t , . � 1
35
—Tr,;, t7 A- 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 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 NO ❑ _� 4
SIZE OF TANK f' ga 1.
NITRIFICATION FIELD �,pjn sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY .`.,M,:r �"� ', raj INSTALLED BY,!?
CERTIFICATE OF COMPLETION Da
By
(8/16/73) *Construction must comply Stith all other applicable State and local re_guiatio s
LOT AREA TV
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