P405 Hwy 601SDAVIE 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 7)-itk,to c'� G i� DATE % !1 • il' % i! PERMIT
N° 405
,
LOCATION tr l s • i t`J o e
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE Q 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 t~ sq. ft.
DEPTH OF STONE IN LINES: In'�
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY;:. `:1'. °r•4c:,
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House
Three Bedroom House mss.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
INSTALLED BY E + ` CO -
CERTIFICATE
Q'
CERTIFICATE OF COMPLETION ByDate d' ? - "
(8/16/73) *Construction must omply with 'all applicable State and local regulations
LOT AREA
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