P692 Main Church RdDAVIE 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 L'Y1rs, 0 6vT r aC, DATE _ ;�� _7.j PERMIT
LOCATION N� 692
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE
BUSINESS
NO. BEDROOMS 3 NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK D?i gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: 2 " le,,,e/ ev P - r -
WATER SUPPLY: Individual Q Public ❑
IMPROVEMENTS PERMIT BY
CERTIFICATE OF COMPLETION
BY—
(8/16/73) *Construction must
LOT AREA
House Trailer
800 Gal.
400
Sq.
Ft.
Two Bedroom House
800 Gal.
600
Sq.
Ft.
Three Bedroom House
900 Gal..)"
900
Sq.
Ftp
Four Bedroom House
1000-Ga1.
1200
Sq.
Ft.
INSTALLED BY
, 09 "1 Date 619, -a a - 76
ly with all other applicable State and local regulations
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