P1015 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 E .'�` i t DATE 'r PERMIT
LOCATION 1015
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME p" BUSINESS ❑
NO. BEDROOMS n NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE wr YES ❑ NO ❑
SIZE OF TANK 1!` 4" gal.
NITRIFICATION FIELD (� sq. ft.
DEPTH OF STONE IN LINES: a.� f fuetl 07t1,(A
WATER SUPPLY: Individual [3 Public
tt ❑
IMPROVEMENTS PERMIT BY
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
INSTALLED BY�2Su+
CERTIFICATE OF COMPLETION By �^ti-ti tx_, Date
s -a..
(8/16/73) *Construction must ODmply with all other applicable State and local regulations
LOT AREA'�`�
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