P399 Hwy 158' DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorpt gn Sewage. sposal System - G.S.
OWNER OR CONTRACTOR_ * Chapter 130 -Article 13C)
IfF;ATE PERMITS
-.:
LOCATION` :>' ..4 ? 1 r ., '•
SUBDIVISION NAME
S. R. NO. J-
LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS
NO. BEDROOMS ,k, NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO
AUTO. DISHWASHER YES ,❑ 91NO [11'
AUTO. WASH. MACHINE YES E"�, NO ❑
SITE SUITABLE YES M-' NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY .- _r'_ .''1!iA,
399
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House $Q0 GSI 600 ,Sq Ft.
Three Bedroom House 900 Gal,�0�„S,q Ftp.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
D BY
CERTIFICATE OF COMPLETIONgy �Z
Y'�i \ Date
(8/16/73) *Construction must c mply with all other applicable State and local regulations
LOT AREA
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