524 Bethel Church Rd -'t DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorp on Sewage DiAp}osal System .; G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR � �` 1,�Y ,� i^ '` -, , _ � " DATE F�-«; - 5 PERMIT
.LOCATION '
-;.>_'_'.", .:='!' •/,fir Y /',r, C�c N? 492
f S.R. N0.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS —,3 NO. BATHROOMS Two Bedroom House Gal. 600 Sq.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House 900 Gal. �0 S Ft.
AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000 Ga 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑ 1=�'
SIZE OF TANK Q gal.'
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: /o? %r.J
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY /~ � INSTALLED BY � �-
CERTIFICATE OF COMPLETION
By— Pr Date
(8/16/73) *Construction must com ly with all
J �other -applicable State and local regulations
LOT AREA ��,J c� !J f �C' S /J "X
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