P419 Hwy 801SDAVIE 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 !,' u _ PERMIT
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LOCATION G ; ' .. 4 l- .r i:, 1 i ' t c ,� - s„ F : '�. c ix 4 t ,� N? 419
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SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
BILE HOME El BUSINESS
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO Er
AUTO. DISHWASHER YES ❑ NO Q"
AUTO. WASH. MACHINE YES 0 NO ❑
SITE SUITABLEn YES 15 NO ❑
SIZE OF TANK 90 gal.
NITRIFICATION FIELD 3 o sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY
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House Trailer 800_.Gal. 4W—Sq.--Ft.
Two Bedroom House80aL,' C(,OO.....S.q•.-»Ft:
Three Bedroom House 900 Gal. 900 Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
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INSTALLED BY 5a 6o ►. i�oraa,IQ
CERTIFICATE OF COMPLETION BY a,, Date //- -2Z''r
(8/16/73) *Construction must co ly with all other applicable State and local regulations
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