P1787 Farmington Rdt DAVIE 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 Yh0117p PERMIT
LOCATION � � �- �'�� - l ry , l� le 1-)1;51 N° 1787
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE EY MOBILE HOME
❑
BUSINESS ❑
"
3-
House Trailer
800
Gal.
400 Sq. Ft.
NO. BEDROOMS NO.
BATHROOMS
Two Bedroom House
800
Gal.
600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES
❑
NO ❑
Three Bedroom House
900
Gal.
900 Sq. Ft.
AUTO. DISHWASHER YES
❑
NO ❑
Four Bedroom House
1000
Gal.
1200 Sq. Ft.
AUTO. WASH. MACHINE YES
❑
NO ❑
'
SITE SUITABLE YES
❑
NO ❑`"-
SIZE OF TANK gal•X;Sf;•,�
NITRIFICATION FIELD
sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual
❑
Public
IMPROVEMENTS PERMIT BY
INSTALLED BY
CERTIFICATE OF COMPLETION
M _
T1 �{
By
Date
(8/16/73) *Construction must
omply with all
other applicable State
and
local
regulations
LOT AREA
A10
DAVIE COUNTY HEALTH DEPARTMENT
r
(Septic Tank) Improvements Permit and Certificate of Completion
(Gr.ound Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR VJa.4 1Q. DATE PERMIT
LOCATION �cra�,��-�-f.,.- ,�'-c� 31q - i »? , /c. 07- i79S/_ P&
S. R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE Iff- MOBILE HOME ❑ BUSINESS ❑
NO. BEDROOMS .3- 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.
DEPTH OF STONE IN LINES:
wTER SUPPLY: Individual ❑ Public (�
IMPROVEMENTS PERMIT BY
1787
House Trailer
800
Gal.
400
Sq.
Ft.
Two Bedroom House
800
Gal.
600
Sq.
Ft.
Three Bedroom House
900
Gal.
900
Sq.
Ft.
Four Bedroom House
1000
Gal.
1200
Sq.
Ft.
INSTALLED BYlcu�Ll�tl.c_�
CERTIFICATE OF COMPLETION
BY Date !&I3Z 7OE'
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
DAVIE 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 r ','ti l ,, i t N �<:,, ,1f�:% :,�N9 1787
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE
BUSINESS
NO. BEDROOMS
NO.
BATHROOMS
400
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.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public
IMPROVEMENTS PERMIT BY
House Trailer
800
Gal.
400
Sq.
Ft.
Two Bedroom House
800
Gal.
600
Sq.
Ft.
Three Bedroom House
900
Gal.
900
Sq.
Ft.
Four Bedroom House
1000
Gal.
1200
Sq.
Ft.
/14
INSTALLED BY �` ,:.,�',`<� �;t-R. ...k
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must comply with all other applicable State and local regulations .
LOT AREA
M.
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