124 Riverside Dr , Q �••- DAVIE,COUNTY HEALTH DEPARTMENT
J (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absor tion Sewage Disposal System - G.S. Chapter 130-Article 13C)
No
OWNER OR CONTRACTOR }�, 1-4,"�-a- DATE ") PERMIT _..
• E
LOCATION :,., ' c'. c• i�r w. 4:.,� . r e� "54 p ,Z 934
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE E MOBILE HOME BUSINESS ❑
House Trailer 800 Gala 400 Sq. Ft.
N0. BEDROOMS N0. 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 [D..—Public ❑ nn
IMPROVEMENTS PERMIT BY /f� �� `^, INSTALLED BY 1-)Q,V i e s lea
CERTIFICATE OF COMPLETION By y Dates I
S-
(8/16/73) *Construction must comply with all ther applicable State and local regulations
LOT AREA
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Re-rni'p;i-c DAVIE COUNTY HEALTH DEPARTMENT
Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR> 1 eL-L �G'�: z: 4 � e DATE_-? 4ERMIT.. .
LOCATION � �t. i�;r 4� E 054 �. Q ke4 � N° 934
4 u.
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME E3 BUSINESS ❑
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 ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Q.''Public ❑
IMPROVEMENTS PERMIT BY61.C., INSTALLED BY
CERTIFICATE OF COMPLETION
By 6tADate S' Z7``j
(8/16/73) *Construction must comply with all th applicable State and local regulations
LOT AREA I`^"'+,PA IN ��� � C.t+'e L
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