P318 Hwy 158DAVIE COUNTY HEALTH DEPARTMENT
*VJ(w
(Septic Tank) Improvements Permit and Certificate of Completion
(Grouti-d-Absl ' kbfip-n-8e''w"'a,ge D�sppsal ystem - G.S. Chapten 130 Arttcle 13C)
0
OWNER OR CONTRACTOR DATE PERIWO
318
LOCATION
Ll S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
4 0C
HOUSE 0 MOBILE HOME fia BUSINESS [I House Trailer raaQ_gal. 4600.sq NO. BEDROOMS NO. BATHROOMS Two Bedroom House IzQLL
GARBAGE DISPOSAL UNIT YES El NO M<-' Three BedrooT House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES 0 NO Four Bedroom Rouse 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES NO ❑
SITE SUITABLE YES NO ❑
SIZE OF TANK gal.
0?
NITRIFICATION FIELD' sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY. Individuda Pub is
IMPROVEMENTS PERMIT BY INSTALLED BY
CERTIFICATE OF COMPLETION9
y IrS ot�s Date 7p? Z/
(8/16/73) *Construction must comr" with all other applicable State and localegulations
LOT AREA