P1716 Wagner Rds
DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C) '�-�•-,-.t�
OWNER OR CONTRACTOR t: /' r A'. .' DATE ! , j ! PERMIT
LOCATION O 1
"716
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE
HOME EF BUSINESS
NO. BEDROOMS
NO.
BATHROOMS
_
GARBAGE DISPOSAL'UNIT
YES
❑
NO
AUTO. DISHWASHER
YES
❑
NO
AUTO. WASH. MACHINE
YES
❑ ,
NO
[
SITE SUITABLE
YES
Q�
NO
❑
SIZE OF TANK
gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Indiv�i dual LJ Public ❑
IMPROVEMENTS PERMIT BY //' ;" r:✓<' l.z .,
CERTIFICATE OF COMPLETION By 1tLA /•
(8/16/73) *Construction mustomply wi a
' a r
LOT AREA t1#_.t , U
c
t.rN P( t
1, t
House Trailer 800 Gal.
Two Bedroom House 800 Gal:.
Three Bedroom House 900 Gal.
Four Bedroom House 1000 Gal.
INSTALLED BY
400 Sq. Ft.
600 Sq. Ft.
900 Sq. Ft.
1200 Sq. Ft.
Date ' j " 1 ' -
other applicable State and local regulations
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