P624 Hwy 64EDAVIE 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 ,, • �" ' DATE sS . -�,, PERMIT
LOCATION_{�Y L +, • '�� t� r + 'S E;. ' ,....� *7 `= `° / fLt E N9
S.R.NO
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME U1 ----BUSINESS
NO. BEDROOMS �tr�. NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO
AUTO. DISHWASHER YES ❑ NO
'AUTO. WASH. MACHINE YES --NO
SITE SUITABLE YES •+Tro ❑
SIZE OF TANK gal.
NITRIFICATION FIELD •;'; .sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual -'Public
felIMPROVEMENTS PERMIT BY � :,...
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
924
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
INSTALLED BY Sri • Co.
CERTIFICATE OF COMPLETION� "
By Date-6r!"
s ' y�—
(8/16/73) *Construction must 6mply with all other applicable State and local..-rregulation s
LOT AREA�',�
1
A4
1 4. per,
4 �
1�