1975 Hwy 158 (4)DAVIE COUNTY HEALTH DEPARTMENT
' (Septic Tank) Improvements Permit and Certificafe, of Completion
(Ground Absorption Sewage Disposal System - G.S. Ch ter 130 -Article 13C)
OR CONTRACTOR t� *lea;; '� fi r r :,3l� DATE q - 1, - 7T4 PERMIT
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LOCATIONa'dY •
SUBDIVISION NAME
HOUSE
LOT NO.
BUSINESS ❑
NO. BEDROOMS �L NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO Q'
AUTO. DISHWASHER YES ❑ NO [Er
AUTO. WASH. MACHINE YES ❑ NO Q"
SITE SUITABLE YES (fr NO ❑
SIZE OF TANK Y eV gal.
NITRIFICATION FIELD 6&-0 sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public
IMPROVEMENTS PERMIT BY
n
S.R. NO.
SECTION OR BLOCK NO.
292
House
Trailer
800 Gal. 400
Sq. Ft.
-
Two Bedroom
House
�Q� � ' 0
S
Three
Bedroom House
900 Gal. 900
Sq. Ft.
Four
Bedroom House
1000 Gal. 1200
Sq. Ft.
7
INSTALLED BY 1[ f -R c t VA .c V,,,' -N r t
CERTIFICATE OF COMPLETION By Dater" -`4
r
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
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