P54 Ijames Church RdDAVIE 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 / ` Y . r c. S _ _ ,1 .f r' _' DATE c2 PERMIT
LOCATION
S.R. NO.
SUBDIVISION NAME LOT NO.
BUSINESS ❑
NO. BEDROOMS 4;- N0. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO
AUTO. DISHWASHER YES ❑ NO M-'
AUTO. WASH. MACHINE YES ®-" NO ❑
SITE SUITABLE YES Cif' NO ❑
SIZE OF TANK it 00 gal.
NITRIFICATION FIELD / .)` �i'3 1 Osq. ft.
DEPTH OF STONE IN LINES: X1.1 -1
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY A-# , �-_ ,
CERTIFICATE OF COMPLETION BY—
(8/16/73) *Construction must c
LOT AREA
............. .
SECTION OR BLOCK NO.
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
I-ru,.
0
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
l�4) 0 J��o::-.j%.
r!
INSTALLED BY
Date t2 - f- % r 9 ' 7CL
ly with all other applicable Statp aud.local regulations
'
6,
13