P225 Gladstone RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disppsal System - G.S. Chapter 130-Article'13G)
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OWNER OR CONTRACTOR Nor1.1,7o.,1 ���:�> f�F.' `:"` DATE PERMIT
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LOCATION
SUBDIVISION NAME LOT NO.
HOUSE ❑ MOBILE HOME ^ 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 ESD gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: ,
WATER SUPPLY: Individual {fid. Public ❑
IMPROVEMENTS PERMIT BY
S. R. NO.
SECTION OR BLOCK NO.
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
STALLED BY
225
800 Gal. 400 Sq. Ft.
1000 Gal. 1200 Sq. Ft.
CERTIFICATE OF COMPLETION ^"% if /r.,By f' � � ��c'... Date to f el
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(8/16/73) *Construction must comp with all other applicable State and local regulations
LOT AREA
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