334 Ijames Church Rd 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 �r
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DATE PERMIT
� +LOCATIONA .. . !`
762
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S.R. N0. /&
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
.� House Trailer NO, al. � 400-Sq-,,,Ft.
NO. BEDROOMS ct NO. BATHROOMS Two Bedroom House 800 Ga 600 S .
GARBAGE DISPOSAL UNIT YES ❑ NO Three Bedroom House 900 Gal. `—:� Sq Ft.
AUTO. DISHWASHER YES ❑ NO Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES j NO ❑
SITE SUITABLE YES ( N0 ❑ C'0`� r3,I
SIZE OF TANK galar
ft'a<a:.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: r ' /
WATER SUPPLY: Individual ® Public ❑
IMPROVEMENTS PERMIT BY ,Tbf MIy-dlo INSTALLED BY C-7A L CA-., o•r1
CERTIFICATE OF COMPLETION V)1 Date ?
(8/16/73) *Construction must &mply with all other applicable State and local regulations
LOT AREA AcRt,-A5J� c."t cr, 1 k', T:>x t'A ,
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