P324 Hwy 158• DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit ,and Certificate of Completion
(Ground.Absorpti n S wage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CbN.,,WCTOR '/ ;> DATE �.. 't PERMIT
j • --� 314
LOCATION
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
NO. BEDROOMS ,'� NO. BATHROOMS ouse�Tr8 l4er _ al•, .
' Two Bedroom House ..800 Gal. 600 Sq., Ft.
GARBAGE DISPOSAL 'UNIT YES ❑ NO Qw� Three Bedroom House'. 900 Gal. 900 Sq..Ft.
AUTO. DISHWASHER YES �❑' . NO Q'""Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WAS$.. MACHINE YES [$ NO ❑'
r.
SITE" SUITABLE' " ' YES ❑ NO ❑
SIZE OF TANK % oZ 1pd gal. o5, ( %�
i
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑ ' '`
/7
IMPROVEMENTS PERMIT BY 4) INSTALLED BY
CERTIFICATE OF COMPLETION '
h By Date Af
+' (8/16/73) *Construction must cly wit all other applicable State and loca regulati s
t LOT AREA y ,�f
t,