P478 Boger RdA
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 :S' "" "7"'- ' PERMIT
LOCATI30N `, �,� �e" ' +,o `.,.� ' s , N� 478
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,_._S.R. N0.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME) BUSINESS ❑
NO. BEDROOMS a^~:; NO."`BATHROOMSF
GARBAGE DISPOSAL UNIT YES CJ NO ❑,.
AUTO. DISHWASHER YES ❑ -NO �ff,
AUTO. WASH. MACHINE YESPNO
0 ( ❑
SITE SUITABLE YES ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual -� Public ❑
IMPROVEMENTS PERMIT BY ,fit:f • `''�
House Trailer , .( .Gal-.� �M Sq k�t
Two Bedroom House j>8Q•Q ZaL! �'y,,(a .Q Sq..„,,,�,.t.
Three Bedroom House 900 Gal. 900 Sq. Ft.
Four Bedroom House . 1000 Gal. 1200 Sq. Ft.
STALLED BY
CERTIFICATE OF COMPLETIONBy -.� Date `� 2_3 i
(8/16/73) *Construction must compl with all -other .applicable..State..and...loca,l...regulat ons
LOT AREA
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