P678 Hwy 158DAVIE 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 N? 678
L4• � .- v..�„ _ �_ S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE E1 MOBILE HOME BUSINESS ❑
NO. BEDROOMS :,
NO.
BATHROOMS
GARBAGE DISPOSAL UNIT
YES
❑
NO
❑
AUTO. DISHWASHER
YES
❑
NO
❑
AUTO. WASH. MACHINE
YES
❑
NO
❑
SITE SUITABLE
YES
❑
NO
❑
SIZE OF TANK
_ gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual T Public ❑
IMPROVEMENTS PERMIT BY
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 800 Gal. 600 Sq. Ft.
Three Bedroom Housex900. Ga1,,;:�,4 900 Sq.
Four Bedroom House td0'U' Gal.
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INSTALLED BY L % '1?1 � --
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must cr
ply with all other applicable State and local regulations
LOT AREA
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