139 Liberty RdDAVIE COUNTY HEALTH DEPARTMENT
_ (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorpt on"Sewag "''Dispos;al System - G.S. Chapter, 130 Article 13C)
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OWNER OR CONTRACTOR ' t l �' Y1 t"' f7�` '' �, DATE �� w=-: ; '-FERMI-T----
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LOCATION �rf:.:? v { _.i' �r` ', {r L -� ,'z•� ;f�'�;-' ,
,!! S.R. NO.
SUBDIVISION NAME
LOT NO. SECTION OR BLOCK NO.
0
HOUSE MOBILE HOME t3 BUSINESS I
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT' YES ❑ NO
AUTO. DISHWASHER YES❑/NO _ ❑Q
AUTO. WASH. MACHINE YES ® NO ❑
SITE SUITABLE YES NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: J._T r.
WATER SUPPLY: Individual 04" P„ublic
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IMPROVEMENTS PERMIT BY._1•
CERTIFICATE OF COMPLETION
By—
(8/16/73) *Construction must
LOT: AREA
1
iAjetia. 1t I
74
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 800 Gal. 600 Sq. Ft.
Three Bedroom House 900 al. OO Sq. Ft.
Four Bedroom House _1000 Gal. 1200 Sq. Ft.
STALLED BY
Date
y with all other applicable State and local regulations
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