6710 Hwy 801S 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 J c i` DATE ''J- . �+ ' } �+ PERMIT
LOCATION F()1 v,t - ► t�F<,� l�k: ._ sir � `�- ,..,r_ -� � p. - N� 1168
. 4 r. S m. {V VO S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS 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. .,k2 00 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK 230 gal. ,^`
NITRIFICATION FIELD 4z.— sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY tllaINSTALLED BY
CERTIFICATE OF COMPLETION { % ',i -
By > Date10— S
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA s`' + 1 + t i; i E.•., i_
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