198 Broadway 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 DATE PERMIT
LOCATION
N° 691
- L-t S.R. NO. 30
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 S Ft.
N0. BEDROOMS J. NO. BATHROOMS Two Bedroom House �.--$00}Ga10Sc . Ftp
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 &400 sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑ ///
IMPROVEMENTS PERMIT BY INSTALLED BY
CERTIFICATE OF COMPLETION B �r �►/� ZC>• ��--
Date
(8/16/73) *Construction must comply with all o0er Applicable State and local regulations
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