P322 Madison RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorpn Sewagg,.Ddsposalystem - G.S. Chapt r 130- ti le 13C)
OWNER OR CONTRACTOR DATEPERMITO
N . 322
LOCATION
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ,meq. MOBILE HOME ❑ BUSINESS
If ,
House Trailer
800
Gal.
400 Sq.
Ft.
NO. BEDROOMS
NO. BATHROOMS
Two Bedroom House
800
Gal.
600 Sq.
Ft.
GARBAGE DISPOSAL UNIT
YES ❑
NO ❑
Three Bedroom House_G
-9.00_.S_q.,,,Ft.
AUTO. DISHWASHER
YES ❑
NO [3
Four Bedroom House
' 1000
Gal
1200 Sq.
Ft.
AUTO. WASH. MACHINE
YES ❑
NO ❑
SITE SUITABLE
YES ❑
NO ❑
SIZE OF TANK !%
gal.
NITRIFICATION FIELD
j���
sq. ft.
DEPTH OF STONE IN LINES: tf
WATER SUPPLY: Individual ❑
Public ❑
;'`;::•,
!
IMPROVEMENTS PERMIT BY
_
1 :"'•� . , .t :
INSTALLED BY
•���'
CERTIFICATE OF COMPLETION
By , �{-._- • •� > 4.. Date
(8/16/73) *Construction must omply with all other applicable State and local regulations
LOT AREA