P373 Martin Luther King Junior 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 e = :. ;1 ! e { j;r:� DATE/,.,) `r' "' PERMIT
LOCATION
r % S.R.NO
SUBDIVISION NAME /I,OT N0. SECTION OR BLOCK N0.
HOUSE ❑ MOBILE HOME 0 BUSINESS ❑
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO
AUTO. DISHWASHER YES ❑ NO ❑"'
AUTO. WASH. MACHINE YES [Er NO ❑
SITE SUITABLE YES 0" NO ❑
SIZE OF TANK gal.�p�,¢"'
NITRIFICATION FIELD �-z _S- sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public 13
IMPROVEMENTS PERMIT BY
CERTIFICATE OF COMPLETION
By.
(8/16/73) *Construction mus
LOT AREA
�-Cl' w 1140 G '.Af
373
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 800 Gal. 600,_Sq. Ft.
Three Bedroom House L900,G.V900_SS Ft
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
..- J
r~ /
INSTALLED BY,r��c�:!��.-r
r��� - •. ,.''p Date T��! r
with all/ither applicable State and local regulations