1267 Baltimore Rdt r 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 to DATE PERMIT
593
LOCATION
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE g' MOBILE
HOME ❑ BUSINESS
NO. BEDROOMS
NO. BATHROOMS
GARBAGE DISPOSAL UNIT
YES ❑ NO ❑
AUTO. DISHWASHER
YES ❑ NO ❑
AUTO. WASH. MACHINE
YES ❑ NO ❑
SITE SUITABLE
YES [3 NO [3SIZE
�y
OF TANK "l n
gal.
NITRIFICATION FIELD
7"c5�(7 sq. ft.
DEPTH OF STONE IN LINES: leclE(ouen
WATER SUPPLY: Individual Q Public ❑
House Trailer
800 Gal. 400 Sq. Ft.
Two Bedroom House
80Q_Ga, 600 Sq_. Ft.
Three Bedroom House
�°'� 00G� 1,,, --9,00 Sq. Ft -
Four Bedroom House
'tOOG Gal. "Y2�t.OCK
IMPROVEMENTS PERMIT BY y y INSTALLED BY 5:7,
CERTIFICATE OF COMPLETION 44 _ -
BY �QM Date � 76
(8/16/73) *Construction must mply with all other applicable State and local regulations
LOT AREA 4, 0 Atr?ES (s.a Lj C- 0f /'A—