275 Madison Rd (2)DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewagepisposal System - G.S. Chap r 130-Article,.13C�
OWNER OR CONTRACTOR DATE ; ERMIT
LOCATION-, �:.�_i'(;r�s f 333
S.R. NO.
SUBDIVISION NAME '
BUSINESS
NO. BEDROOMS ar,,S NO. BATHROOMS
LOT NO. SECTION OR BLOCK NO.
GARBAGE DISPOSAL UNIT YES ❑ -NO ET"
AUTO. DISHWASHER YES �C/ NO ❑
AUTO. WASH. MACHINE YES � NO El
SITE SUITABLE YES Q" NO ❑
SIZE OF TANK n gal.
NITRIFICATION FIELD f t.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual -A Public ❑
IMPROVEMENTS PERMIT BY
House Trailer
�:wedroom House
t.Thr� ree Bear om Hous
Four Bedroom House
C�z ,
800 Gal. 400 Sq. Ft.
800 Gal. 6QQ Sc,L. _Ftp
(90_ 0 Gal. [900 Sq.
1000 Gar. 1200 Sq. Ft.
INSTALLED BY
CERTIFICATE OF COMPLETION
By
. ;'"-^'-''� Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
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