100 W Maple AveDAVIE COUNTY HEALT 1 DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Dimes osal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTORs 1j J)1,, J��_ r� .P 7��. DATE 0-,3 Q -')- ...PERMIT
LOCATION N9
W r 0 r- f-, p'� , � S. R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE
HOME EJ 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
gal.
1200
■
■
CIO 'i
House Trailer
800
Gal.
400
Sq.
Ft.
Two Bedroom House
800
Gal.
600
Sq.
Ft.
Three Bedroom House
900
Gal.
900
Sq.
Ft.
Four Bedroom House
1000
Gal.
1200
Sq.
Ft.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY J � .� .G�✓.�Z•Ge , _ INSTALLED BY ° �" Zea -c ���L �� f � S
CERTIFICATE OF COMPLETION
By Date d
(8/16/73) *Construction must C'om'pW with all other applicable State and local regulations
%
LOT AREA . ' Ca ( �i/ f ' Ut- ,.Q U e. /
' ' 1 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 +, , . _ ; ,z s%<.� .� % t %✓.z-� DATE .^s - ',,-!—PERMIT
LOCATION _N9 369
�+."+ , of : 7, S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK N0.
-I
HOUSE ❑' MOBILE HOME 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 gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY
CERTIFICATE OF COMPLETION
BY—
(8/16/73) *Construction must
LOT AREA
House Trailer
800
Gal.
400
Sq.
Ft.
Two Bedroom House
800
Gal.
600
Sq.
Ft.
Three Bedroom House
900
Gal.
900
Sq.
Ft.
Four Bedroom House
1000
Gal.
1200
Sq.
Ft.
INSTALLED BY
Date
with all other applicable State and local regulatio s
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