P1365 Junction 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 I r ,�'. ► ic?' DATE ; ; PERMIT
LOCATION ,j ,a,, c, ,,,`
N°
SUBDIVISION NAME
HOUSE
BUSINESS
S. R. NO.
LOT NO. SECTION OR BLOCK NO.
NO. BEDROOMS .'I)
NO.
BATHROOMS -")--
GARBAGE DISPOSAL UNIT
YES
❑
NO
600
AUTO. DISHWASHER
YES
❑
NO
Q"
AUTO. WASH. MACHINE
YES
®
NO
❑
SITE SUITABLE "
YES
[3
NO
[3SIZE
OF TANK �I CJ gal.
NITRIFICATION FIELD
sq. ft.
DEPTH OF STONE IN LINES•
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
WATER SUPPLY: Individual ❑ Public r0i IA
1365
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
IMPROVEMENTS PERMIT BY (;ve INSTALLED BYb,e-
CERTIFICATE OF COMPLETION
BY � ` Y: Date 1-/-77
(8/16/73) *Construction must corny with all other applicable State and local regulations
LOT AREA r�
JO `
��. D (1: 5,0