P398 Gordon DriveA s
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` Y w�a°t�,� � � $` r �'� � ��� `� DATE /I` � " / `"PERMIT
t N°
LOCATION f` a +; : 'i ✓ 398
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE
LE
r
NO. BEDROOMS _ NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑
AUTO. DISHWASHER YES ❑
AUTO. WASH. MACHINE YES ❑
SITE SUITABLE YES ❑
SIZE OF TANK gal.
Ili NITRIFICATION FIELD 0 �'
NO ❑
NO ❑
NO ❑
NO. ❑
sq ft.
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual
y./
Public ❑
IMPROVEMENTS PERMIT BY
rel.,
��1 `}.'._ ?' ="i~ t';-�.
INSTALLED BY
CERTIFICATE OF COMPLETION
By ! :, �".; , 3 -�- i-.. --
Date �.
(8/16/73) *Construction
must comply with all
other applicable State and
local regulations
LOT AREA
i