P55 Gladstone RdDAVIE 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 j +.. rn ; , ' . DATE a f rte' --PERMIT
F, ° 55
LOCATION
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME p BUSINESS ❑
NO. BEDROOMS 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 n sq. ft.
.r
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY
er
CERTIFICATE OF COMPLETION
By
(8/16/73) *Construction must comp
LOT AREA
House Trailer 800 Gal. 400 Sag. Ft.
Two Bedroom House 800 Gal. Ft.
Three Bedroom House 900 Gal. 900 Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
INSTALLED B�,,.L�P
4 / Ltf .ria Date r,2 —//-- 4 --
with all other applicable State and local regulations
a