3817 Hwy 64W Lot 19DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
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(Ground Absor tion Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR . *' "�l (;5 ,- ► T" ; e u% 4DATE '' `� ; PERMIT
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LOCATIONar,!
SUBDIVISION NAME
S. R. NO.
LOT NO. 21 SECTION OR BLOCK NO.
HOUSE )A MOBILE HOME ❑ BUSINESS ❑
NO. BEDROOMS NO. BATHROOMS i I -
GARBAGE DISPOSAL UNIT YES ❑ NO 0
AUTO. DISHWASHER YES [ NO ❑
AUTO. WASH. MACHINE YES NO ❑
SITE SUITABLE YES NO ❑
SIZE OF TANK gala
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Publico
IMPROVEMENTS PERMIT BY"�-
CERTIFICATE OF COMPLETION
BY—
(8/16/73) *Construction must
LOT AREA IDOX ;ZOO
loo
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 0.0__ al O,Q- aq. Ft.
Three Bedroom House 900 SgF',
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
J,✓e/eoat
INSTAL�ED BY Z444W
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Date
y with all other applicable State and local regulations