P354 Hwy 158it. 4h
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 DATE PERMIT
LOCATION
X, N? 354
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE Ej MOBILE HOME BUSINESS ❑
NO. BEDROOMS NO. BATHROOMS
House Trailer
Two Bedroom House
300 Gal.
1-'=
jQO�Gal
Ft.
[�_00 Sq Ft
GARBAGE.DISPOSAL UNIT YES 0 NO 02-7
Three Bedroom House
900 Gal.
9 6*rit:--T
AUTO. DISHWASHER YES ❑ NO
Four Bedroom House
1000 Gal.
1200 Sq. Ft.
AUTO. WASH. MACHINE YES NO
SITE SUITABLE YES ❑ NO ❑
SIZE OFTANK gal.
NITRIFICATION FIELD sq. ft.
.j
A
DEPTH OF STONE IN LINES:
WATER SUPPLY: -Individual Public ❑
IMPROVEMENTS PERMIT BY
INSTALLED BY
-Z, --T Co.
CERTIFICATE OF COMPLETION
By
%
Date
(8/16/73) *Construction mustc ply with all
other applicable State
and local
regulations
LOT AREA
N o S -e c
P-—