P67 Calahaln RdDAVIE COUNTY HEALM DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR % tJ i r i.r DATES f' - r% < PERMIT
67
LOCATION ( jr a -. r;•s� __ . /� r' v " i' s''
SUBDIVISION NAME
5.,R. NO.
LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
4
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY
CERTIFICATE OF COMPLETION
By—
(8/16/73) *Construction must
LOT.AREA
House Trailer
800
Gal.
400 Sq.
Ft.
Two Bedroom House
4:_800._Ga,1.
' 600 tS
Ft.
Three Bedroom House
900
Gal.
900 Sq.
Ft.
Four Bedroom House
1000
Gal.
1200 Sq.
Ft.
r
INSTALLED BY It '�
'j t,�- , Date R —��
with all other applicable State and local regulations
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