1561 Main Church Rd (3)DAVIE COUNTY HEALTH DEPARTMENT
.. .(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorptign Se a Disposal System - G.S. Chapter 1q -Ar t. le 13C)
OWNER OR CONTRACTOR — (,( rr" r" ��'" ft �',/r��� DATE �+ �" s PERIKO
LOCATION :;11-
t -3;
SUBDIVISION NAME LOT NO.
HOUSE ❑ MOBILE HOME ZI BUSINESS
NO. BEDROOMS ter. NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES 5 NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY '►,,` /r'�"
CERTIFICATE OF COMPLETION. By71
(8/16/73) *Construction must c-o�mmpp-'
LOT AREA
i
S.R. NO. if ^ -.-
SECTION OR BLOCK NO.
177
House Trailert2al. 400
Two Bedroom House Ft.
Three Bedroom House 900 Gal. 900 Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
vj. to i From e%c 4 6or.
INSTALLED BY
&14--l Date V..�%(o— 2V
with all other applicable State and local regulations
/;140 ?'5
b• � �
io
�► e t � tit , � �, � � i Zjr
!/o f i
• ,
- - 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 ,- jr 7'e { ,--7
/l ins DATE PERMIT
LOCATION Cp o /AL t S t' �d �ec� �.� q/ a& Ce 7cQ, ^t— N° 177
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME EZ BUSINESS ❑
House Trailer 800 Gala 400 S . Ft.
NO. BEDROOMS 0171— NO. BATHROOMS Two Bedroom House 1800 Gal. 1600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES UR-' NO ❑
SITE SUITABLE YES ❑ NO ❑ tl /7 -
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑ �q��r /'�` �< <'r•
IMPROVEMENTS PERMIT BY C NSTALLED BY 9Y l q mok 9` c4roy -
CERTIFICATE OF COMPLETION By Date �( --Z6 _I !
' � T
(8/16/73) *Construction must compl with all other applicable State and local regulations
LOT AREA
oc
.
L L2 ��D` fed
j)afn
400
/,0
dao