356 Martin Luther King Junior Rd (2) DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
yOWNER OR CONTRACTOR ' 'f DATE /'> f/,1� PERMIT
Fra y N°
LOCATION ��1i7�� i/r- r I '�" 832
17
J • , a i.r ` . S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE to MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400,–Sq. Ft.
NO. BEDROOMS NO. BATHROOMS t"----,.",_.,_ """'
�s Two Bedroom House 8( 00 Gal' 600 Sq. Ft
GARBAGE DISPOSAL UNIT YES ❑ NO ( Three Bedroom House 900 Gal. 900-9q7 '`f.
AUTO. DISHWASHER YES ❑ 0 QM-- Four Bedroom House 1000 Gal. 1200 Sq. Vit.
AUTO. WASH. MACHINE YES ED NO ❑
SITE SUITABLE YES (�`' NO ❑ 4 dtr�1 �.'," --<Is t 1"•r`.'C
SIZE OF TANK gal.
NITRIFICATION FIELD 410 sq. ft. }
DEPTH OF STONE IN LINES: '
WATER SUPPLY: Individual ❑ Public
IMPROVEMENTS PERMIT BY INSTALLED f,.«`�Sr;�%•f c' ^r�, INSTALLED BY
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CERTIFICATE OF COMPLETION MBY Date
(8/16/73) *Construction must mply with all other applicable State and local regulations
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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 CONTRACTOR ,� i d►{- 4f Y-► DATE 2- Fj- PERMIT
-- _ . _
LOCATION J 832
Q S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
A 6e
HOUSE MOBILE HOME E3 BUSINESS ❑
House Trailer 800 Gal. 400aSq.
Ft.
NO. BEDROOMS _ Q NO. BATHROOMS �,! Two Bedroom House 800 Ga 600GARBAGE DISPOSAL UNIT YES ❑ NO L�- Three Bedroom House 90 Ga 9
AUTO. DISHWASHER YES `❑ 0 [ "' Four Bedroom House 1000 Gal. 1200 Sq. t.
AUTO. WASH. MACHINE YES t� O ❑ r , O
SITE SUITABLE YES [ ° NO ❑ �' �; J p ��� �j @ tij�Aeq�
SIZE OF TANK gal.
NITRIFICATION FIELD 4 's sq. ft.
DEPTH OF STONE IN LINES: �� k
WATER SUPPLY: Individual ❑ Public --A u n�'�n�
IMPROVEMENTS PERMIT BY INSTALLED B
CERTIFICATE OF COMPLETION
By Date
(8/16/73) *Construction must c y with all other applicable State and local regulations
LOT AREA o-t S- T-76
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