P255 Davie Academy Rd4 DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements_ Permit sand_ Certificate- of .Completion
s(Ground'Absorption Sewage -Disposal System G.S. Chapter 130 -Article 13C)-
OWNER OR CONTRACTOR ', ` r DATE t, ; si PERMIT
LOCATION 1 N? 255
S. R. NO. .rz/.4
..SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE p MOBILE HOME ❑ BUSINESS ❑
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ®1 NO ❑
AUTO. DISHWASHER YES ►❑', NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE ) YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD a�q. ft.
DEPTH OF STONE IN LINES: /
WATER SUPPLY: Individual [ Public ❑
IMPROVEMENTS PERMIT BY
f
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
800 Gal. 400 Sq. Ft.
800 Gal. 6QQ sq -:-..Et.
i, -5m0 G�a 1 J µ'
1000 Gal. 1200 Sq. Ft.
INSTALLED BY J
CERTIFICATE OF COMPLETIONDate 1" 0"
UN.
BY ���' •
(8/16/73) *Construction must cooly with all other applicable State and local regulations
LOT AREA