P165 Woodland•+.. .. ter,. DAVIE COUNTY HEALTH DEPARTMENT
,. (Septic Tank) Improvements Permit and Certificate of Completion
(Ground„Absor tion Sewage Disposal System - G.S. Chapter 130-Art:Lc -I13C)
OWNER OR CONTRACTOR ` �'•, P '+ »' !;.' DATE' `"Ch PY '
`RMIT
N° 165
LOCATION
S.R.
NO.
SUBDIVISION NAME '04>d XQR "4j LOT NO. SECTION OR
BLOCK NO.
HOUSE MOBILE HOME BUSINESS Cl
-House Trailer 800
Gal. '400 Sq. -Ft.
NO. BEDROOMS NO. BATHROOMS
Two Bedroom House Rn„_nL',
al1Q4,.9,L_Ft..
GARBAGE DISPOSAL UNIT YES. ❑ , NO �
Three Bedroom House 00 QO S . Ft..
��!�� �..
AUTO. DISHWASHER YES &' NO ❑
Four Bedroom House 1000
Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES Ei�N0 ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: ,k"
WATER SUPPLY: Individual Public
IMPROVEMENTS PERMIT BY r r.z�+'d4l
INSTALLED BY
CERTIFICATE OF COMPLETION
By
Date
(8/16/73) *Construction must comply with all other applicable State and
local regulations
LOT AREA�S�•�
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DAVIE COUNTY HEALTH DEPARTMENT
K (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal cSystem - G.S�DATE 'haptery130-Articl �l
MIT
OWNER OR CONTRACTOR _ /1')+.,,j ,!�/ e rj a RMIT
LOCATION /» 165
S.R. NO..
SUBDIVISION NAME &14J LOT NO. JO # 4rSECTION OR BLOCK NO.
HOUSE MOBILE HOME.. 0 BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS NO. ',,BATHROOMS .,.,/ Two Bedroom House 8 al. 60 Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO LT Three Bedroom House 90.0 Gal 00 Sq. Ft.
AUTO. DISHWASHER YES Flo" NO ❑ Four Bedroom House 10 0 Gal. 1200 Sq. t.
AUTO. WASH. MACHINE YESNO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
r wiles
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY LIT35we4AC INSTALLED BY
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA OZS� .xOO
0