193 Pineville RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Se
wage Disposal System G.S. Chapter 13 le 13C)-, U/
OWNER OR CONTRACTOR
DATE PERMIT
LOCATION'" a res < �►,'/, �n
S.R. NO.
SUBDIVISION NAME 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 gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY
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ol
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 800 Gal. 600
Three Bedroom House 900 a- 900 S Ft
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
D BYO- C�r ! / e=35��
CERTIFICATE OF COMPLETION By r✓_'.�" i ' "`��' ► kol � Date
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(8/16/73) *Construction must com with all other applicable State and local regulations
LOT AREA
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4'