P562 Pineville Rd5..,, 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�; �•„ �•.1 <.,,_ f:� :w Yr .�� DATE �j - ! ' 7 PERMIT
..� No 562
LOCATION _ _ � 1i � ��� � i (C;. � �� z�. c�:, w i� e.� i t: a. � � �� :a �, 1 •� c:. , t c R� a-�. � � . e �
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE
BUSINESS ❑
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 2 gal.
NITRIFICATION FIELD Q sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual fa Public ❑
IMPROVEMENTS PERMIT BY
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 6 t.
Three Bedroom House 900Gala 00 S Ft
Four Bedroom House 00 Gala 1200 Sq. Ft.
p
l y
INSTALLED BYj/
CERTIFICATE OF COMPLETION : By / 1 -,V-
�, Date /O` ee- ,>.P,
(8/16/73) *Construction must compl, with all other applicable State and local regulations
LOT AREA ��1 ►t' e lQ t- 9
i