P543 Hwy 801Ss l DAVIE 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 , ,o[a /[j�. DATE �' PERMIT
-� �" .. - No 543
LOCATION .
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE
BUSINESS
NO. BEDROOMS A'A 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 sc. ft.
DEPTH OF STONE IN LINES: i-77
WATER SUPPLY: Individual Q Public ❑
IMPROVEMENTS PERMIT BY
CERTIFICATE OF COMPLETION
By zrlc
(8/16/73) *Construction must comp with a
LOT AREA S
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
800 Gal. 400 Sq. Ft.
800 Gal:'- -66 Sq. Ft:a
900-G 900--9-q ~Ft.
1000 Gal. 1200 Sq. Ft.
INSTALLED BY
Dateother applicable applicable State and local regulations