P221 Myers Rd" DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Dispgsa� System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR l• 4 ---DATE.;)--j PERMIT-
. `
No
LOCATION U/iJ*I-- r4l''•.' .r.�:.v�, %` ` `2� f
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE Z] MOBILE HOME ❑ BUSINESS C
NO. BEDROOMS / NO. BATHROOMS,
GARBAGE DISPOSAL UNIT YES ❑ NO
AUTO. DISHWASHER YES ❑ NO
AUTO. WASH. MACHINE YES ❑ NO
SITE SUITABLE YES [ NO ❑
SIZE OF TANK _qjrj.3 gal.
NITRIFICATION FIELD 6�4>„ sq. ft.
DEPTH OF STONE IN LINES: CC
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY IZ. r /s� �" v�-�•Z�L
CERTIFICATE OF COMPLETION By'�_
(8/16/73) *Construction must c
LOT AREA
221
House Trailer
800 Gal.
400
Sq.
Ft.
Two Bedroom House
800 Gal.
600
Sq.
Ft.
Three Bedroom House
900 Gal.
900
Sq.
Ft.
Four Beg3�oom House
1000 Gal.
1200
Sq.
Ft.
.0 d
t0A,e_ .,tsCj,r:
I" a 1
INSTALLED BY
�y }' �,; r ,,,_. 4.., Dater / i'-
ly with all other applicable State and local regulations
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f
'*DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absornti%n,S(ewase Disposal Sys/tem - G.S. Chapter 130-A'cle 13C)
OWNER( OR CONTRACTOR J C / C !7 &- V.— r r, Q`t' r"" DATES -3 /—)rtPERMIT
LOCATION Zr�' 4 XI&P I N?
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE �] MOBILE HOME ❑ BUSINESS
NO. BEDROOMS �_ NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ . NO
AUTO. DISHWASHER YES ❑- NO/
AUTO. WASH. MACHINE YES �❑ NO
SITE SUITABLE i YES p NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD Z10 sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individuate Pu is ❑
IMPROVEMENTS PERMIT BY
• /,
CERTIFICATE OF COMPLETION By
*Construction must
LOT AREA
221
House Trailer
800 Gal.
400
Sq.
Ft.
Two Bedroom House
800 Gal.-
600
Sq.
Ft.
Three Bedroom House
900 Gal.
900
Sq.
Ft.
Four Be oo House
1000 Gal.
1200
Sq.
Ft.
I)Al ' ' o alrz
1.0 o (5-q I
to a� ldlrzr++ 1sQd 0�4t� A -,-I- wAr
UOf
'Z,[!�Y-..
INSTALLED BY !A) Ate.
Date '��Z_
ly with all other applicable State and local regulations
K; r