P953 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 �? ',..x:.�,�'"� r DATE _ , - PERMIT
LOCATION r�,k' !.' �•, " f',� �e } t �'. ? ' 1\ 9 9 5 3
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S.R. NO. f 0 e0 r.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS NO. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO Qr' Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO 03-*— Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES 0--'- NO ❑ l
SITE SUITABLE YES Q ---NO ❑ •i lkJi � -^* j �.a 1 lJc-�. rj � `;X ;� rid !'+�/��xc.�r' � E'er �' f
SIZE OF TANK r !� gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public
IMPROVEMENTS PERMIT BY 1STALLED BY i
CERTIFICATE OF COMPLETIONJ J .,� %11 01
BV Date
(8/16/73) *Construction must corn y with all other applicable State and localfregu atiol
LOT AREA ,�
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