7630 Hwy 801S (2) ' " 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 DATE D y PERMIT
LOCATION i !. N9 891
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE Elo' 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. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑ �t'?`. Z?•
SIZE OF TANKgal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual 0-"Public
❑
IMPROVEMENTS PERMIT BY ?'.+ INSTALLED BY
CERTIFICATE OF COMPLETION �� �¢__ /
By Date O—�G
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA /
Y
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 DATE - ? - ?/_ PERMIT
LOCATION 891
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
N0. BEDROOMS N0. 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 ❑ ,i
SIZE OF TANK 2,00. gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES; c-�� ✓r.c.. �'
WATER SUPPLY: Individual (Public ❑
IMPROVEMENTS PERMIT BY �,,,� tMr� . .��.�>__ INSTALLED BY _v
CERTIFICATE OF COMPLETION
By l Date
(8/16/73) *Construction must Omply with all other applicable State and local regulations
LOT AREA ,