P737 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 � �lG ' s;, -t,/G. t � 1 1 a �; s? f € a i 5 ,
% DATE /,,-I , � r" PERMIT
r
LOCATION �'' �� d 4" 43 pU i` M. u /; N6 737'
S.R. NO.
SUBDIVISION NAME LOT NO.
HOUSED ❑ ' 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 ,.❑ Public ❑
IMPROVEMENTS PERMIT BY A -
SECTION OR BLOCK NO.
House Trailer
800
Gal.
400
Sq.
Ft.
Two Bedroom House
800
Gal.
600
Sq.
Ft.
Three Bedroom House
900
Gal.
900
Sq.
Ft.
Four Bedroom House
1000
Gal.
1200
Sq.
Ft.
INSTALLED BY
CERTIFICATE OF COMPLETION `By c .-rn"
Date � ���-7
(8/16/73) *Construction must comp y with all other applicable State and local regulations
LOT AREA
• , , --� //0'X3 X2�'� .�
r
r
0
yy^_