661 Liberty Church Rd (2) DAVIE COUNTY HEALTH DEPARTMENT
r �
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR Wk)I C._ G r �� n, DATE - /L1~ ,:. PERMIT
LOCATION `, }, ..� s 1 r. �. r,n r�_ N? 582
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE W MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS Z NO. BATHROOMS Two Bedroom House 80 al. 6
GARBAGE DISPOSAL UNIT YES El NO ❑ Three Bedroom House 0900 G 900 S F
AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE �+ YES [�"" NO ❑
SIZE OF TANK /CYO gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual [ Public ❑
IMPROVEMENTS PERMIT BY � �, �_, INSTALLED BY
CERTIFICATE OF COMPLETION
BY Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA 1`'N� Sc�`j( 1 ' ue�
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