7722 Hwy 801S (2) DAVIE COUNTY HEALTH DEPARTMENT
Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absor t Sewa a Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTORDATE PERMIT
LOCATION ! . �. 1\ 1215
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
Ix A
HOUSE ❑ MOBILE HOME BUSINESS
t 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 [�j
SITE SUITABLE YES ❑ NO ❑ _
SIZE OF TANK ' ..f gal.
NITRIFICATION FIELD r sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public [] f i
k",r e'
IMPROVEMENTS PERMIT BY f INSTALLED BY
CERTIFICATE OF COMPLETION
By ,
y ° Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA