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DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and -Certificate -of--EOmpletion
(Ground Absorption)-Sewatge'DTs`posal System - G. S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR ' ,+� •� ?�; '^ i_. t ,fr +'`r_ _ DATE ==14- PERMIT
LOCATION s;'rcf i i `;� `r • ...a 1
S. R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE
HOME ❑ BUSINESS
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO El"
AUTO. DISHWASHER YES �❑,,,+- NO ❑'
AUTO. WASH. MACHINE YES U o ❑
SITE SUITABLE YES E2" NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:"`I
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY
CERTIFICATE OF COMPLETION
By
(8/16/73) *Construction must c
LOT AREA
s
f
$i
%1
t
i
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
INSTALLED BY
800 Gal. 400 Sq. Ft.
LGal_ F
� 0
1000 Gal. 1200 Sq. Ft.
[2=
Date
ly with all other applicable State and local regulations
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