241 Bell Branch Rd DAVIE COUNTY HEALTH DEPARTMENT
' (Septic Tankements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR + !t { 1)t.,l,y,<,.,;. •, .t DATE - ^: J/,,, PERMIT C
LOCATIONt i a` c. - A c,.�t <.n. 1['. 116 5
S.R. NO. (a q
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft,
:7,%NO. BEDROOMS
-% House
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 ❑ NO ❑
SIZE OF TANK —qO0 gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ! Public ❑
IMPROVEMENTS PERMIT BY INSTALLED BY ,
CERTIFICATE OF COMPLETION e,�'ro�•c�b- Date 18-1-110
BY
(8/16/73) *Construction must c mply with all other applicable State and local 'regula`tions
�t.l.
LOT AREA
�J
1
8�
a �