P544 County Line 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 PERMIT
LOCATION z N� 544
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBIL
NO. BEDROOMS
GARBAGE DISPOSAL UNIT
AUTO. DISHWASHER
AUTO. WASH. MACHINE
SITE SUITABLE
SIZE OF TANK
NITRIFICATION FIELD
HOME ❑ BUSINESS
NO.
BATHROOMS
YES
❑
NO
YES
❑
NO
YES
❑
NO
YES
❑
NO
gal.
■
■
■
■
sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public
IMPROVEMENTS PERMIT BY
IN]
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 800 Ga -1. 600_Sq,_ Ft;
Three Bedroom House x`900 Gal.., ,-900 Sq._Ft..`•
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
INSTALLED BYn S 1
CERTIFICATE OF COMPLETION
By �t,�-e_ Y�c�..� c�....i Date !%
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA 9 #el2es
N; ..