P68 Gladstone RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorptio71 Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR DATE c- - % f ^ "i4ERMIT
y f0 68
LOCATION L_`� r �:3 r r s,, d ; ! t ^- r, M r,�, r v� . ;'//c r ; %.:, r / u r ? C r
S. R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE
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 sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual
IMPROVEMENTS PERMIT BY
CERTIFICATE OF COMPLETION
(8/16/73)
LOT AREA
Public ❑
House Trailer 800 Gal. 400ASq. Ft.
Two Bedroom House A2 Gal. (1600\Sq. Ft.
Three Bedroom House 900 Gal. 900 -Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
INSTALLED BY _ .i.c,t
T
BY 11—' Date 2,
must
*Construction with ;�1M�ther
=-
applicable State and local regulations
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