P149 Baileys Chapel RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvemeri64Wrmit said Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
` ?/' PERMAITTjr O E �z�it.na DATE °
149
LOCATION 11 A.;e /-V'
r. IN N0.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE RQ MOBILE HOME U BUSINESS C
NO. BEDROOMS NO. BATHROOMS :•
GARBAGE DISPOSAL UNIT YES ❑ NO
AUTO. DISHWASHER YES,❑,/ NO Q'
AUTO. WASH. MACHINE YES L1 NO ❑
SITE SUITABLE �. YES ❑ NO ❑
SIZE OF TANK ?fd� gal.
NITRIFICATION FIELD yfey sq. ft.
DEPTH OF STONE IN LINES:�
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BYa�*..-Yusat+r:+t
CERTI
(8/16/73)
LOT AREA
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 80�y.tL...'
Three Bedroom House
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
INSTALLED BY f Jt%-
OF COMPLETION
lz�e - Date
*Construction must comply with all other applicable State and ..local regulations
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