844 Wagner Rd (2)DAVIE COUNTY HEALTH DEPARTMENT
Y i (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR ��,, ` C r o r P] ! I DATE PERMIT
LOCATION pPc Rd- --1=0 (fPz- btrTti a- mac• ) N° 127
ki - S. R. NO. 1 3/v
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOMEA BUSINESS [
NO. BEDROOMS 2 NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO
AUTO. DISHWASHER YES ❑ NO
AUTO. WASH. MACHINE YES NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK 9- jV oo``C3gal.
NITRIFICATION FIELD 7` D sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY C�r-P
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
INSTALLED BY
800 Gal.
00 Gal
900 Gal.
1000 Gal.
400 Sq. Ft.
600 Sq. Ft.
900 Sq. Ft.
1200 Sq. Ft.
CERTIFICATE OF COMPLETION By � F�� � L J� Date I --
must
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(8/16/73) *Construction must omply with all other applicable State and local regulations
LOT AREA
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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 DATE 3a - % PERMIT
t No
LOCATION � (� i � t,e..z r- :_, ►� �_ �� t`. t� � ,� t � � - C... �: � "T' �-�, �.,. �� : Q h.
SUBDIVISION NAME
S.K. NO. / ,.-0 J
LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME AM BUSINESS ❑
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO
AUTO. DISHWASHER YES ❑ NO
AUTO. WASH. MACHINE YES A NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK erg gal.
NITRIFICATION FIELD ! sq. ft.
DEPTH OF STONE IN LINES:��
WATER SUPPLY: Individual (, Public ❑
IMPROVEMENTS PERMIT BY Ce6rC
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
INSTALLED BY 0 t
127
800 400
Sq.
Ft.
800 qa 600
Sq.
Ft.
900 Gal. 900
Sq.
Ft.
1000 Gal. 1200
Sq.
Ft.
)v% o-. -
CERTIFICATE OF COMPLETION By UVC r ill.. -I zu Date - 0 -
(8/16/73) *Construction must Implywith all other applicable State and local regulations
LOT AREA
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