P1201 Legion Hut RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR 1 a'? ��"( ri �.Y r f ,.�, r ,'r' DATE ' - f ` %. PERMIT
LOCATION r ,_..1�' ,'` NO
Lf I '`" S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME] BUSINESS ❑
NO. BEDROOMS NO. BATHROOMS c:
GARBAGE DISPOSAL UNIT YES ❑ NO ❑`
AUTO. DISHWASHER YES ❑ NO 12'"'
AUTO. WASH. MACHINE YES O"' NO ❑
SITE SUITABLE YES ❑ "'NO ❑
SIZE OF TANK S) U gal. 4 f
NITRIFICATION FIELD Sc(. ft.
DEPTH OF STONE IN LINES: .e
WATER SUPPLY: Individual ❑ Public L^
IMPROVEMENTS PERMIT BY
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
1201
800 Gal. 400 Sq. Ft.
800 Gal. A,600_Sq ,-Ft,.
",�9Y00 Gal. 900, Sq _Ft.'
1000 Gal. 1200 Sq. Ft:
BY
~cM
CERTIFICATE OF COMPLETION By ,, , Date /19jS`" rl
=� —z -r
(8/16/73) *Construction must 'co y with -all other applicable State and local regulations
LOT AREA