P101973 Fork Bixby Rd�D(L�DEP _ _
K
(SEPTIC
TANK IMPROVEMENTS P T AND CERTIFICATE OF COMPLETION
(Ground Absortion Sewage Dispo 1 System - G.S.,Chapter 130 -Article 13C)
OWNER OR CONTRACTOR SCP DATE — PERMIT N0.
LOCATION
SUBDIVISION -NAME
S.R. NO.
LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME [J BUSINESS
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES [� NO 0
AUTO. DISHWASHER YES Q NO ❑
AUTO. WASH. MACHINE YES D NO LT
SITE SUITABLE - YES 0 NO =j
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public d
IMPROVEMENTS PERMIT BY
CERTIFICA
(8/16/73)
TE OF COMPLETION BY
LOT AREA
I
INSTALLED BY
%�' aid i
DATE 12b —1 Y—
*Construction must�c4/iy with all other applicable State and local regulations
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