187 Dogwood Lane Lots 144-146` DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage )DisposalSystem - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR .!,y✓r�n+�:+ti ;,t...� {i.,,,�r"4 4 DATE PERMIT
LOCAT.iON � �g4IAVrci
No
s S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE
INESS
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
1720
800
Gal.
400
Sq.
NO. BEDROOMS
NO.
BATHROOMS
GARBAGE DISPOSAL UNIT
YES
❑
NO ❑
AUTO. DISHWASHER
YES
❑
NO ❑
AUTO. WASH. MACHINE
YES
❑
NO ❑
SITE SUITABLE
YES
❑
NO ❑
SIZE OF TANK 167V
gal.
NITRIFICATION FIELD
sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual
0'
Public ❑
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
1720
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
IMPROVEMENTS PERMIT BY .1'Y1 � I INSTALLED BY "/,, + �•
CERTIFICATE OF COMPLETION
By—
(8/16/73) *Construction must
LOT AREA
%L&' "'' Date
Ay with all other applicable State and local regulations
1
l 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 .!,%?i,�n�:�.ti ;,t•:. I L%t; �w•c,. DATE PERMIT
LOCAfT? ON N9 1720
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE W MOBILE HOME ❑ BUSINESS
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ N0. ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK /d7V gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY Q.\. Ma --A -,
CERTIFICATE OF COMPLETION
BY—
(8/16/73) *Construction must
LOT AREA
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
INSTALLED BY n...,.. + &'lot
Date
?ly with all other applicable State and local regulations