123 Forest Court Lot 34DAVIE COUNTY HEALTH DEPARTMENT �
w (-otic Tank) Improvements Permit and Certificate of Completion
(Ground Absxption Sewa 4e isposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR'"YJ, i (. �A�:v} j r r DATE ERMjIIT p
LOCATION 7` ` ` M O 4 0 1
S.R. NO.
SUBDIVISION NAME
NO. BELROOMS NO. BATHROOMS s
GARBAGE DISPOSAL UNIT
YES
NO
❑
AUTO.
DISHWASHER
YES
NO
❑
AUTO.
WASH. MACHINE
YES M
NO
Q
SITE
SUITABLE
YES
NO
[3SIZE
OF TANK
gal.
NITRIFICATION FIELD
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual
IMPROVEMENTS PERMIT BY
(8/16/73)
LOT AREA
LOT NO.
sq. ft.
r�
Public . ❑
By
*Construction must
SECTION OR BLOCK NO.
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 800 Gal. 600 Sq. Ft.
Three Bedroom House 900 Gal. 900 Sq. Ft.
Four Bedroom �House 1000 Gal. 1200 Sq. Ft.
�aajC3 x
INSTALLED BY
i,& Date 7—,16-71—
with all other applicable State and local regulation&.