P1125 Gywn St• DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Grbund Absorption Sewage Dispos 1 System - G.S. Chap er 130 -Article 13C)
OWNER OR CONTRACTOR P,
G. ! i" DATE PERMIT
LOCATION 1125
S. R. NO. AaCAUq
SUBDIVISION NAME LOT N0. SECTION OR BLOCK N0.
HOUSE ❑ \,,,MOBILE HOME BUSINESS ElNO. BEDROOMS .� N0. BAATHRRO-'OMS
GARBAGE DISPOSAL UNIT YES NO ❑
AUTO. DISHWASHER YES 0 NO
AUTO. WASH. MACHINE YES [$''- ❑
SITE SUITABLE YES [ NO ❑
SIZE OF TANK gala
i
NITRIFICATION .FIELD cp 4'=r' sq. ft.
DEPTH OF STONE IN LINES: le R
WATER SUPPLY: Individua)104
[ Public ❑
IMPROVEMENTS PERMIT BY s r i
CERTIFICATE OF COMPLETION
BY—
(8/16/73) *Construction must
LOT AREA
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
STALLED BY 4 CLll
1 y, Date Z-,2'//- 2
ly with all other—applicable State and local regulations