P286 Hwy 801S•, 0
DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
- '- (Ground Absorption Sewage Disposal System - G.S. Chanter 130-Arti,�e.,,13C)
OWNER OR CONTRACTOR DATE PERMIT
��.. N° 286
LOCATION t7 �- -' Tca S h 0 t r, tY
' S.R. N0.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME ❑ BUSINESS ❑
NO. BEDROOMS" 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 sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY
O'House Trailer
Two Bedroom House
800 a„
1'900 Gales
400.§_zt.
q,,,,,
x 60 Sq,F,_
Three Bedroom House
900
Gal.
900 Sq. Ft.
Four Bedroom House
1000
Gal.
1200 Sq. Ft.
INSTALLED BY
CERTIFICATE OF COMPLETION � l
By c � 1l_rw-�.�-.f', Date
(8/16/73) *Construction must cdmply with all other applicable State and local regulations
LOT AREA
47�
F t'
L.i