541 Davie Academy Rd (2) DAVIE COUNTY HEALTH DEPARTMENT
•r ' (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR Breve. �''`o H-S DATE 7-a 3-7h PERMIT
LOCATION ��;CI�� l�c� M crus C' , IC F-�' �ieFo r hc•;c.��t CS
+'O 1077
Q+- na,t e fkcA. S.R. NO.
SUBDIVISION NAME. LOT NO. SECTION OR BLOCK NO.
HOUSE [E' MOBILE HOME tj BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS D. 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 q b_D gal. olf--� CV1--.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: au" IP,.CI We.,, h L42- L -7
WATER SUPPLY: Individual ( Public ❑
IMPROVEMENTS PERMIT BY INSTALLED BY n
CERTIFICATE OF COMPLETION BY �t�cr�„�.� DateIn'�9-7L
(8/16/73) *Construction must omply with all other applicable State and local regulations
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