P699 Liberty Church 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 _ (',: ,-1� 5 C,r.. ►, ►� E e� DATE PERMIT
LOCATION �'
.�.►r�i, C1.r�:f- �-••���4��J� 4.4 �{. ."f eti�rr.lF�r:••,...a;J,f.� O 699
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME C' BUSINESS ❑
NO. BEDROOMS 2 NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD 404 sq. ft.
DEPTH OF STONE IN LINES: /S',??otk
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BYt-�,1'1�f)nrc1
House Trailer 80 a t.
00 Gl. �4 Sq--
Two Bedroom House a
Three Bedroom House 900 Gal. 900 Sq. Ft.
_Four Bedroom House 1000 Gal. 1200 Sq. Ft.
i
U�
INSTALLED BY %, •Vu •�o�t,5
CERTIFICATE OF COMPLETION By �'. DatelA-/5' 7S
(8/16/73) *Construction must com ly with all other applicable State and local regulations
LOT AREA
a