P408 Bethel Church RdDAVIE 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 �:."" 1'" r'`f` PERMIT -
LOCATION t� N? 408
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ( MOBILE
HOME ❑ BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS
NO. BATHROOMS
Two Bedroom House 800--GaL_ Sg-F.t-,
GARBAGE DISPOSAL UNIT
YES ❑ NO ❑
r,b00..
Three Bedroom House 90D—S-q.._�'
AUTO. DISHWASHER
YES RNO ❑
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE
YES NO ❑
l�irt� g r 7 +
SITE SUITABLE
YES [3 NO ❑
Li
SIZE OF TANK 1�
gal.'
NITRIFICATION FIELD
G--a-zi sq. ft.
DEPTH OF STONE IN LINES: /rn
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY
�f°�� 'tr��' !
INSTALLED BY " "o- , �. �•�r^
CERTIFICATE OF COMPLETION cr,i �, � ` �,,, D 0 _ „ 7V
By _ ,�\�
Date o
(8/16/73) *Construction must comply with all
other applicable State and local regulations
LOT AREA
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