530 Liberty Church RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption SewageDisposalSystem - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR/ `' - •:.. :' _° ;f `' C %'.' c=' '+" S DATE
PERMIT
.... �..
Ij° 243
_ -...
LOCATION
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
1
N0. BEDROOMS { N0. BATHROOMS _
House Trailer
Two Bedroom House
Gal. 400 Sj,„,v t.
00 Gal. 600Scp Ft%
GARBAGE DISPOSAL UNIT YES El90
NO 0
Three Bedroom House
900 Gal. 0 Sq. Ft.
AUTO. DISHWASHER YES ❑�, NO Q"
Four Bedroom House
1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ( NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD ,- sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ggMblic ❑
.IMPROVEMENTS PERMIT BY �;'• �. .. ,`_.,} p.�;:�
f•
INSTALLED BY
CERTIFICATE OF COMPLETION ��
By *:'
r A� 7
Date !Z—Ag-
(8/16/73) *Construction must 4Fly with a 1 other applicable State
(8/16/73)
and local regulations
LOT AREA