P269 Legion Cemetery StDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage bfsUsa j System_,- G.S. Chapter 130 -Article --13C)
OWNER OR CONTRACTOR �/�1 , yyi �6 P DATE � — �"%7� PERMITO C n
LOCATION YVI , S"rt re c --T-- �o a eC- me-e—A 26 J
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO..
HOUSE ❑ MOBILE HOME U BUSINESS ❑
NO. BEDROOMS ?, NO. BATHROOMS •
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ J,NO
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES D NO ❑
SIZE OF TANK 7507 gal.
NITRIFICATION FIELD (O a7% sq. ft.
DEPTH OF STONE IN LINES: (�
WATER SUPPLY: Individual, Public ❑
IMPROVEMENTS PERMIT BY 4 ''
House Trailer §,0Q. -Ga -j,., 400 SA.. Rt_.
Two Bedroom House ��'800 Ga --;"600 SQLt-
Three Bedroom House 900 Gal. 900 Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
INSTALLED BY D C�J{ie. `� T• Co•
CERTIFICATE OF COMPLETION By �, ' t1 :.. • Date r " .3c> - 70;(
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
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