189 Sparks Rd _ Y DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System G.S. Chapter 130-Article 13C)
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OWNER OR CONTRACTORF�- � p „ , DATE
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LOCATION "c_ b-° j 't f f N9
_ �, . �, ,��! lti,. a ...t ,` .� . , ;� _, �,,. � 1280
ti 1.�-9! '`',�,n ✓; :y, <,� .�.. -T S.R. NO. 44,�,5 +`
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SUBDIVISION NAME LOT NO. SECTION OR*BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 40_0_S . Ft.
NO. BEDROOMS NO. BATHROOMS Two Bedroom House ' 8b-0 ar. 600 Sq Ft ”
GARBAGE DISPOSAL UNIT YES ❑ NO ( --�"'" Three Bedroom House �.' 0"Sq:^—Ft':
AUTO. DISHWASHER YES ❑ NO Q_ . - Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES NO ❑ , _� 1 , :.
SITE SUITABLE YES NO ❑ ?.. r , r
SIZE OF TANK gal.
NITRIFICATION FIELD ft.
DEPTH OF STONE IN LINES: ,yt*11
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WATER SUPPLY: Individual Public ❑
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IMPROVEMENTS PERMIT BY1� r_ ._ 5�°'v�G!_�.a� INSTALLED BY <4
CERTIFICATE OF COMPLETION ByDate
(8/16/73) *Construction must co with a 1 other appl cable State and loca regulations
LOT AREA !
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