P624 Broadway RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Dis osal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR ) i� DATE ",? .;z4---7S'P IT
LOCATION L a n,vj3Ns ,Ci c"�t: Cp1Cj4'.�t). r Jr,E L' o 624
�5 r�•y ,� .R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME 9?'- BUSINESS [
NO. BEDROOMS . NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO I�
AUTO. DISHWASHER YES ❑ NO
AUTO. WASH. MACHINE YES ($a'.NN ❑
SITE SUITABLE / YES-L�'-40 ❑
SIZE OF TANK ,j. gal.
NITRIFICATION FIELDsq. ft.
DEPTH OF STONE IN LINES:A, ;� `'fir-t�, ve-'
WATER SUPPLY: Individual Lam! Public ❑
IMPROVEMENTS PERMIT BYf ' fZ
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
/ /3- or -
x
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
INSTALLED BY �A��L %T' CO,
CERTIFICATE OF COMPLETIONBy e 10- -Not- 7)
Date
(8/16/73) *Construction must compl.9 with all other applicable State and local regulations
LOT AREA
korf 7.!r- �1- �Jvm svell
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