P406 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 r�o •..� r �y{� DATE /'//- 7V- PERMIT
LOCATION ti 01 ;` , .'i 1.,'. <<c, �+ 3 ►� . c_ �� C` � '
N9 406
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE M MOBILE HOME U 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 Cf sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY!:�`�t�,:C�
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 8OD-fa 60.Q..S4_._J�t.
Three Bedroom House 00r„�Q0 Sq - Ft
Four Bedroom House 1000 Gal. 12000 S
INSTALLED BY
CERTIFICATE OF COMPLETION By rn Q Date
(8/16/73) *Construction must co y with all other applicable State and local regulations
LOT AREA
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9