329 St Matthews Rd (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 )�� +, 3 ;,,_ + DATE ,7 PERMIT
LOCATION j' e: r 14 �,r j lr 1009
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S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
NO. BEDROOMS -`. NO. BATHROOMS House Trailer 800 Gal. 400 Sq. Ft.
_ 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 C3" Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK /'/r`Yr� gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY Cn: lis ,! INSTALLED BY
CERTIFICATE OF COMPLETION By Date '.] - "7(p
(8/16/73) *Construction must c ply with all other applicable 1State and local regulations
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