4360 Hwy 158DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
K._.Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR j/a )M/,'" t/V Q �c�f:,�Al' DATE 2 0- i PERMIT
N° 330
LOCATIONt cZ%G
SUBDIVISION NAME
S. R. NO.
LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS
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 q 6V gal.
NITRIFICATION FIELD to aU sq. ft.
DEPTH OF STONE IN.LINES:
WATER SUPPLY: Individuals Public ❑
IMPROVEMENTS PERMIT BY
"use Trailer POO Cal.
IAN2 edroom House 1800a P-
t
ree Bedroom House 900 Gal. 900 Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
�Xi�l %r✓ 9 �o yrs C-
TALLED BY
I -
CERTIFICATE OF COMPLETION BY Date g 11-
(8/16/73) *Constction must mply with all other applicable State and local -regulations
LOT AREA 1
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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 f•' 14, ' s»! .f,.'rr ? % %::DATE d#` _ "�
PERMIT
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330
�1.
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LOCATION ? IrN
S.R.
NO.
SUBDIVISION NAME LOT NO. SECTION OR
BLOCK NO.
HOUSE MOBILE HOME BUSINESS ❑
"
NO. BEDROOMS NO. BATHROOMS
Trailer
two 600 S
Zoo
Bedroom House800
Ga
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
Wr5ree Bedroom House 900
Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO ❑
Four Bedroom House 1000
Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
,4 T'hv AC'S -e_
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
~
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY ` r :-,
NSTALLED BY �� �C :^
a sr
Ull
CERTIFICATE OF COMPLETIONDat
Bye„ .j
e
(8/16/73) *Construction must mply with all other applicable State and
local regulations
t
LOT AREA
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