842 Sain Rd DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absor ti Sey�age ,pisposal System - G.S. Chapt r 130-Article 13C)-
OWNER OR CONTRACTOR �_ :! ( 7 ,,, r" -� `' t't�i PERMIT
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LOCATION .- '. . . tom,. "r J„ /%..f-.'G.- *TO 1124
1J S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE `A MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO.. B ROOMS NO. BATHROOMS Two Bedroom House 800 Gal. 600 },
GARBAGE DISPOSAL UNIT YES ❑ NO L� Three Bedroom House O Ga _ S . Ft.
AUTO. DISHWASHER YES ®-ANO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES �'" ID ❑
SITE SUITABLE YES N ❑ �� ir. � J'��- � t-�
SIZE OF TANK ,0 eD gal. —”
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NITRIFICATION FIELD ' ,S'Zl sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual, �� Public ❑ r,
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IMPROVEMENTS PERMIT BY � _ _ ' �1..s�=��"��''`�-s''--��.- INSTALLED BY < /, ,►
CERTIFICATE OF COMPLETION
BY � "'� Date
(8/16/73) *Construction must comp with all other applicable State and local regulations
LOT AREA
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