P729 Hwy 158DAVIE COUNTY HEALTH DEPARTMENT,
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption 3 Sewage Disposal System - G.S. Chapter 13,0 -Article 13C)
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OWNER OR CONTRACTOR j ;: ;,� �:T;_p ,:� DATE •- r .>� `P J ` PERMIT
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11i° 729
LOCATION �-'� j.', j tri, ., t .. ; f .
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME ❑ BUSINESS ❑
NO. BEDROOMS —0<NO. BATHROOMS
GARBAGE DISPOSAL UNIT ► YES ❑ NO
AUTO. DISHWASHER YES ❑ NO
AUTO. WASH. MACHINE YES [ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK _ t� Q gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: �� _ /'6
WATER SUPPLY: IndividualPublic ❑
IMPROVEMENTS PERMIT BY , �.f°rY.tZ
CERTIFICATE OF COMPLETION By _
(8/16/73) *Construction must comp with al
LOT AREA {. C 'r f .S
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House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House X80 I '��rSq. Ft
._._.... .
Three Bedroom House 0 Ga . 9bb— qA[
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
INSTALLED BY
v v Date
other applicable State and local regulations
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