P1841 Rainbow 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 ;_ { +" DATE ,a'� `s�/ 5 PERMIT
LOCATION �:,�,�"' {��` ; v'�;, ,� ;, .. ; X7.;4: N9 1841
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME p" BUSINESS ❑
House Trailer
800
Gal.
400 Sq. Ft.
NO. BEDROOMS NO. BATHROOMS
Two Bedroom House
800
Gal.
600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO 0 "
Three Bedroom House
900
Gal.
900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO 0'
Four Bedroom House
1000
Gal.
1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑- NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.L
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY�,'t•;,,�'�°c.1�,(�'c.�
INSTALLED BY s
I
-
CERTIFICATE OF COMPLETION
By
Date
(8/16/73) *Construction must comply with all
other applicable State and
local
regulations
LOT AREA
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