780 or 794 Cana RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic. Tank) Improvements Permit and Certificate of Completion
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(Groun.d.Absorption-Sewage Disposal System G.S. Chapter 130 -Article 13C)
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OWNER OR CONTRACTOR L101y - 0 UjfL cRt7 ,.,
DATE
LOCATION N9" 214
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SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE Pq MOBILE HOME BUSINESS 0
NO. BEDROOMS j NO. BATHROOMS
House Trailer 800"Gal.
400 Sq: Ft.
Two Bedroom House 800 Gal.
600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES('`NO
900 -Gal.
900 Sq. Ft.
AUTO. DISHWASHER YES -NO ❑
Four Bedroom House 1000 Gal.
1200 Sq. Ft.
AUTO. WASH. MACHINE YES [Pool NO ❑
SITE SUITABLE YES ❑ NO, M
SIZE OF TANK 4n gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public
IMPROVEMENTS PERMIT BY
INSTALLED BY 1). -
CERTIFICATE OF COMPLETION By
Date
(8/16/73) *Construction must comply with all
other applicable State and local
regulations
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1973.
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