P1085 Gladstone Rd.. _ 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 S4 e U e- DATE a %L PERMIT
LOCATION
I �11'
S. R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE
HOME U BUSINESS ❑
N0. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO C'
AUTO. DISHWASHER YES ❑ NO Q'
AUTO. WASH. MACHINE YES NO ❑
SITE SUITABLE YES NO ❑
SIZE OF TANK 906 gal. 'pa_%f. a %:r. to
NITRIFICATION FIELD 012- sq. ft.
DEPTH OF STONE IN LINES: 191r crve-. ?.I
WATER SUPPLY: Individual ❑ Public
1085
House Trailer
800
Gal.
Ft.
Two Bedroom House
800
Gal.
4&00 Sq. Ft
Three Bedroom House
900
Gal.
900 Sq. Ft.
Four Bedroom House
1000
Gal.
1200 Sq. Ft.
IMPROVEMENTS PERMIT BYINSTALLED BY
CERTIFICATE OF COMPLETION
BY Date �-/3T�a
(8/16/73) *Construction must c mply with all other applicable State and local regulations
LOT AREA �`Iz P&reS o �X �� X " I e u e
w
veli.
1.3N X3 '1��4'' l�.c�-