P270 Hwy 801NDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground.Absorption Sewage Di'sposal''S'stem - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR p. DATE PERMIT
LOCATION �h / Y�.amu. nr_ L�� .......:`.....w .�...• .
SUBDIVISION NAME
HOUSE
HOME 0 BUSINESS
r,
NO. BEDROOMS
NO.
BATHROOMS
GARBAGE DISPOSAL UNIT
YES
❑
NO
O
AUTO. DISHWASHER
YES
[2
NO
AUTO. WASH. MACHINE
YES
0
NO
❑
SITE SUITABLE
YES
❑
NO
❑
SIZE OF TANK �.
gal.
S. R. NO.
LOT NO. SECTION OR BLOCK NO.
NITRIFICATION FIELD i' sq. ft.
DEPTH OF STONE IN LINES: iso`' - ^1'
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY
CERTIFICATE OF COMPLETION
BY—
(8/16/73) *Construction must
LOT AREA
270
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 800_Gal. 6Q0...Sq_-._F.t.
Three Bedroom House t, —00 Gal..-' Sq.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
INSTALLED BY 9'//, -5 507, Ca -
Js_ `r.,(,0,11tkb Date S
ly with all other applicable State and local regulations
C31 X 3
q1 0
!09X3
Mme.. w
f ff
k 1
s 1