P1132 Hwy 158DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground -Absorption Sewage DisposaltSystem - G.S. Chapter 130-Art"ible-13C)
OWNER OR CONTRACTOR
DATE - c� y t
5 1 c 1%r , PERMIT
1
LOCATION
SUBDIVISION NAME LOT NO.
HOUSE
HOME ,R BUSINESS
NO. BEDROOMS .
NO.
BATHROOMS
GARBAGE DISPOSAL UNIT
YES
❑ NO [t ---
AUTO. DISHWASHER
YES
❑ P(] '�
AUTO. WASH. MACHINE
YES
[D^"NO ❑
SITE SUITABLE /'
YES
IM NO
SIZE OF TANK
gal.', �s►�,,,r�r%G}
NITRIFICATION FIELD 49 6 0 sq. ft.
DEPTH OF STONE IN LINES: /?t,..,*,
S. R. NO.
SECTION OR BLOCK NO.
1132
House Trailer
80 400
S
Ft.
Two Bedroom House
800
Gal. 600
S .
Ft.
Three Bedroom House
900
Ga . 900
Sq.
Ft.
Four Bedroom House
1000 Gal. 1200
Sq.
Ft.
-7—
Y
WATER SUPPLY: Individual Public ❑
s(
IMPROVEMENTS PERMIT BY +.,./, Jf�INSTALLED BY
CERTIFICATE OF COMPLETION
By-�.„. L�C.G�"itt Date _� p” �►�
(8/16/73) *Construction must cozarj�.y with all other appli—cable State and local regulations
LOT AREA
j r i✓Z. f �i�F"s ."' k .