P301 Pineville RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Amprovements Permit and Certificate of -Completion
(Ground Absorption Sewage Disposal
,' . f �•'„t tSytgr 130 -Article 13C) -�
Chap
OWNER OR CONTRACTOR /!�'!1
DATE i ji" f PERMIT
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LOCATION i `: • '; • f !+' 1 �� ... �� ev .` ,.
SUBDIVISION NAME
HOUSE
LOT NO.
BUSINESS ❑
NO. BE'DRQOMS Cq q NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑,�*'"� ~-NO ❑
AUTO. WASH. MACHINE YES r! :-NO ❑
SITE SUITABLE YES [-'r' NO ❑
SIZE OF TANK gal
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ,,°� Public ❑
IMPROVEMENTS PERMIT BY i'. :� �a�•'+`'-'-"-
S. R. NO.
SECTION OR BLOCK NO.
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
301
800
Gal.
400
Sq. Ft.
800
Gal.
600
Sq. Ft.
900
Gal.
900
Sq. Ft.
1000
Gal.
1200
Sq. Ft.
i% y t!
/ J2 k1 � , . r.s
INSTALLED BY
CERTIFICATE OF COMPLETION By Date 7—/6z �-' g
(8/16/73) *Construction must C'o&fly wllt'g all other applicable -State and local regulations
LOT AREA )Fe_rr4X
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