374 Foster Dairy RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Dis osal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR �; •t y,/� ,. DATE ,7 _" _-� 1 PERMIT
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LOCATIONIr
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SUBDIVISION NAME
LOT NO.
HOUSE F1 MOBILE HOME ❑ BUSINESS ❑
NO. BE6ROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ -NO
AUTO. DISHWASHER YES �� 0
AUTO. WASH. MACHINE YES L0— ,;NO ❑
SITE SUITABLE YES ® NO ❑
SIZE OF TANK ` nC gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: Sl��
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY 7� . 1i )..'�4�-:tet_
S.R. NO. fry^
SECTION OR BLOCK NO.
1279
House Trailer
800 Gal.
400 Sq. Ft.
Two Bedroom House
800 Gal.
600Sg. Ft.
Three Bedroom House
900 Gal
a 900 D,4
Four Bedroom House
1000 Gal.
200 Sq Ft
INSTALLED BY U�25 l • J,
CERTIFICATE OF COMPLETION ByDateA��7_,Z—
(8/16/73) *Construction must com ly with all other applicable State and local regulations
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