2727 Hwy 601S (3) DAVIE COUNTY HEALTH DEPARTMENT
• (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absor 4ion Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR _ DATE I/� ,�� ,` PERMIT
LOCATION802
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i' S.R. NO.
SUBDIVIS N NAME LOT NO. SECTION OR BLOCK NO.
HOUSE • � MOBILE HOME BUSINESS ❑
,j_ House Trailer 800 Gal. 400 Sq. Ft.
NO. BFJ)ROOMS _ NO. BATHROOMS ^v- Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO [ Three Bedroom House 6'dt aI� 900 Sq. Ft.
AUTO. DISHWASHER YES C3 NO [, Four Bedroom House '):GU-r aT 1200 Sq. Ft.
AUTO. WASH. MACHINE YES NO ❑ ,� ^"" L. 1
SITE SUITABLE YES N ❑
SIZE OF TANK Q'D gal. 4;
NITRIFICATION FIELDjpQQ sq. ft. ✓�� rt"r�'S
DEPTH OF STONE IN LINES: We tl ''' U '�'" .�t't
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WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY --e4, a INSTALLED BY /
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must comp with all other applicable State and local regulations
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