139 Hank Lesser Rd 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 L c..sisotF DATE /1a-/y' "x " PERMIT
LOCATION - t° �" (���,� ,� 1 c�. L�r-c `�.t, ! 17�t ! Ar) �� N� (r�
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SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ M4$ft-E-110ME BUSINESS ❑
1' CAIJ1rrtla-„ House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS ' NO. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES JZ NO ❑ Three Bedroom House '1,,--900Ga >. X00 Sg _Ftp
AUTO. DISHWASHER YES ❑ NO [j? Four Bedroom House 0 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES E+d' NO ❑ 1 ` ' `-C.►.a
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SITE SUITABLE YES NO ❑ i`
SIZE OF TANK goo gal. 1,-C1.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: If"ttvcl Cun44)
WATER SUPPLY: Individual ❑ Public �$(
IMPROVEMENTS PERMIT BY INSTALLED BY �1�� i-` CO •�` c�C )
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CERTIFICATE OF COMPLETION By � Date
(8/16/73) *Construction must mply with all other applicable State and local regulations
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