P636 Hwy 801NDAVIE COUNTY HEALTH DEPARTMENT
-- (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disosal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR ' , p .. DATE -7 1..ry. PERMIT
j / N° 636
LOCATION --....�!: t,I r i 1 6 .,� t-4 : t' r r,. (.. r �
S.R. N0.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ('"" MOBILE HOME ❑ BUSINESS ❑
,OleN0. BEDROOMS d House Trailer
N0. BATHROOMS
Two Bedroom House
GARBAGE DISPOSAL UNIT YES LQ' -NO ❑ Three Bedroom House
AUTO. DISHWASHER YES Er NO ❑ Four Bedroom House
AUTO. WASH. MACHINE YES 0010' -NO ❑
SITE SUITABLEr} YES C7 NO [3SIZE OF TANK ,s� . CO gal. — X 111'
NITRIFICATION FIELD e �i-,I sq. ft.
DEPTH OF STONE IN LINES: / t;, ;A./, 11► 'e ! %<
WATER SUPPLY: Individu,>, Ere Public ❑
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
r
IMPROVEMENTS PERMIT BY INSTALLED BY1'.)1 ( • ST• W'r �c�.. • Sri
CERTIFICATE OF COMPLETION
BY—
(8/16/73) *Construction must
LOT AREA
- rn0,4� Date %S—
ly with all other applicable State and local regulations
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