P1419 Hwy 601S_ DAVIE 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 L)i c4 I -j DATE ✓; .r PERMIT
LOCATION [N3k ik t
N°
SUBDIVISION NAME
S. R. NO.
LOT NO. SECTION OR BLOCK NO.
HOUSE P MOBILE HOME ❑ BUSINESS
NO. BEDROOMS :3 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 0 sq. ft.
DEPTH OF STONE IN LINES: 0�It `
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
1419
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
INSTALLED BY
T
CERTIFICATE OF COMPLETION By \ �QM p Date I-) t.77
(8/16/73) *Construction must co ply with all other applicable State and local regulations
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