P524 Liberty Church Rd- . 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 } ; �, • .• 1' ' ` r DATE - `t;. ! PERMIT
LOCATION i {, ! .� t! . - ► -... lr 524
-- `i C ;'-I - �-t ��� ►4, 1- f 1, � �. �_ S. R. NO.
SUBDIVISION NAME LOT NO.
HOUSE Q MOBILE HOME ❑ BUSINESS I
NO. BEDROOMS N0. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK Uo gal.
NITRIFICATION FIELD to 1,V sq. ft.
DEPTH OF STONE IN LINES: `;?`I
WATER SUPPLY: Individual 9 Public ❑
IMPROVEMENTS PERMIT BY
SECTION OR BLOCK NO.
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 800 Gal. 6,00 _Sq.,_.Ft.
Three Bedroom House 2D_O. GaL.` t 900 Sq. Ft:
Four Bedroom House 1000 Gal. 1260�q. Ft.
INSTALLED BY
CERTIFICATE OF COMPLETION
By Date
(8/16/73) *Construction must mply with all other applicable State and local regulations
LOT AREA ► , �f Kt:� ,, �'
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