P792 Hwy 801NDAVIE 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 !: ••} %' PERMIT
LOCATION tr! ! •� , s; 1\ 792
• i;i
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBIL:
NO. BEDROOMS
GARBAGE DISPOSAL UNIT
AUTO. DISHWASHER
AUTO. WASH. MACHINE
SITE SUITABLE
SIZE OF TANK
BUSINESS
NO. BATHROOMS
YES ❑
NO
❑
YES ❑
NO
❑
YES ❑
NO
❑
YES ❑
NO
❑
gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY Individual Public ❑
IMPROVEMENTS PERMIT BY
House Trailer 800 -Gal. 400 Sq. Ft.
Two Bedroom House '800 Gah� 600 Sq. Ft
-_ ...... _._It
Three Bedroom House —900 -Cal. —900=Sq.- Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
INSTALLED BY
CERTIFICATE OF COMPLETION
By— � . �,�r� Date
(8/16/73) *Construction must comp with all other applicable State and local regulations
LOT AREA ,
—'. Pr
r
f
/O d X 3 ,4,f
12 '