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402 Village Rd DAVIE COUNTY HEALTH DEPARTMENT (Septic Tank) Improvements Permit and Certificate of Completion (Ground Absorption_,Sewage Dispos System - G.S. Chapter 130-Article 13C) OWNER OR CONTRACTOR DATE J.1-12--'2 )---PERMIT LOCATION �4© ;d ` N° 811 .R. NO. SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO. HOUSE ❑ MOBILE HOME tj BUSINESS ❑ House Trailer 800 Gal. 400 Sq. Ft. N0. 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 ❑ SIZE OF TANK gal. NITRIFICATION FIELD sq. ft. DEPTH OF STONE IN LINES: WATER SUPPLY: Individual ❑ Public ❑ IMPROVEMENTS PERMIT BY INSTALLED BY CERTIFICATE OF COMPLETION By OL I Date 4- 30 - 74 (8/16/73) *Construction must comply with all of e: applicable State and local regulations LOT AREA ere 1 II p 7�lON G T NC? '� f � off` GYO.wd