P874 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 i' ! i t _ -'is°til : u' ('C;.. DATE i .. "`+rr. - / PERMIT p
LOCATION �~^�- ,1. _i,n�t l::, .. t �„ +fit r �. 1\� 074
S.R. NO. 41.79
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE
BUSINESS
NO. BEDROOMS R3 NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ®` NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK r n c" gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public
r.
IMPROVEMENTS PERMIT BY
CERTIFICATE OF COMPLETION
BY—
(8/16/73) *Construction must c
LOT AREA
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House ---8_00"Gal > 600 Sq. Ft.
Three Bedroom House"-�30'�"'al. 900 Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
INSTALLED BY 4%, tAf, ,�
2_. rrN,r. b Date a -Z/ - 71,
ly with all other applicable State and local regulations
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