P1101 Jack Booe RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorpti n Sewage Disposa System - G.S. Chapter 130 -Article 13C)'
OWNER OR CONTRACTOR DATE PERMIT
LOCATION - l �' r _ . lr 1101
S.R. NO. j3 3
r' SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME' BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
N0. BEDROOMS N0. BATHROOMS Two Bedroom House, .,800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO '031_ Three Bedroom House 900 Gal.. 900 Sq. Ft.
AUTO. DISHWASHER YESi��io
❑ NO Four Bedroom House, '1000„Gal. 1200 Sq. Ft.
AUTO. WASH.. MACHINE YES 0 ❑
SITE SUITABLE YES_SIZE{ OF TANK IT -2.7. gal.� f
NITRIFICATION FIELD sq. fto ,
DEPTH OF STONE IN LINES:
�rotM .tl.C� d d rs�n
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY—INSTALLED B
CERTIFICATE OF COMPLETION
BY Date�-^
(8/16/73) *Construction must com with all other app icable State and loc regulations