P813 Lakewood Village Rdt 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 DATE '
/"� j jS' PERMIT
LOCATION �` •. `�rir ` -� �. - �7 '�? <'' �{� /-� °� lr? 813
-- - - S.R. NO.
SUBDIVISION NAME �l c: �;.gc�r�%!• %�o� LOT NO.
HOUSE MOBILE HOME U BUSINESS ❑ `
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK g'O gal.
NITRIFICATION FIELD (0-30 sq. ft.
DEPTH OF STONE IN LINES: 1'4 -2 -el' VI 0-y;
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY J l.0 C-,4 rJ
CERTIFICATE OF COMPLETION
By <
(8/16/73) *Construction must c y wi
LOT AREA
ON OR BLOCK NO.
House Trailer
800 Gal. 400 Sq. Ft.
Two Bedroom House
800 Gal. 600 Sq. Ft.
Three Bedroom House
900 Gal. 900 Sq. Ft.
Four Bedroom House
1000 Gal. 1200 Sq. Ft.
IAI
yY�x. .
V I P !'Ira Ci
INSTALLED BY �' .�.�, �,?, ��� If
Dates/)- /7"9,�
all other applicable State and local regulations
Ju X-
�
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 DATE ; ,t`'';j - PERMIT
LOCATION > ' J� J NO 813
S.R. NO.
SUBDIVISION NAME ;' I .: ! 1�' , .,; LOT NO. �- �;:�SECTION OR BLOCK NO.
HOUSE [I MOBILE HOME BUSINESS ❑
CERTIFICATE OF COMPLETION
By
(8/16/73) *Construction must'cbmply with all other applicable State and local regulations
LOT AREA
i
S
House Trailer
800
Gal.
400 Sq. Ft.
NO. BEDROOMS
NO.
BATHROOMS
Two Bedroom House
800
Gal.
600 Sq. Ft.
GARBAGE DISPOSAL UNIT
YES
❑
NO ❑
Three Bedroom House
900
Gal.
900 Sq. Ft.
AUTO. DISHWASHER
YES
❑
NO ❑
Four Bedroom House
1000
Gal.
1200 Sq. Ft.
AUTO. WASH. MACHINE
YES
❑
NO ❑
,
;'
SITE SUITABLE
YES
❑
NO ❑
,_a ., ,, -
., r
�" .� _ �; c" .
SIZE OF TANK
gal.
NITRIFICATION FIELD
_ '
sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual
�❑
Public ❑
IMPROVEMENTS PERMIT BY
_
.i, r`
INSTALLED BY �' 4-r r `}
'
, C �;,•/''1
CERTIFICATE OF COMPLETION
By
(8/16/73) *Construction must'cbmply with all other applicable State and local regulations
LOT AREA
i
S