P166 Woodland: DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground bsorpt on Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR S _ Q M C DATE .3-- �'►`►PERMIT
LOCATION 166
S.R. NO.
SUBDIVISION NAME q q,/ LOT NO. / Z. SECTION OR BLOCK NO.
HOUSE
NO. BEDROOMS
LE
GARBAGE DISPOSAL UNIT
AUTO. DISHWASHER
AUTO. WASH. MACHINE
SITE SUITABLE
SIZE OF TANK
BUSINESS
NO. BATHROOMS
YES' ❑
NO
YES r
NO
YES
NO
YES ❑
NO
_ gal.
■
■
■
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual VlidIMPROVEMENTS PERMIT BY I�
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 8M Gal. 6 Sq.
. Ft.
Three Bedroom House 9 Gal. 00. Ft.
Four Bedroom House 1000 Gal. 120 Ft.
INSTALLED BY
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA /`
DAVIE COUNTY HEALTH DEPARTMENT
• (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorptton Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR ,j 1 -' C` S ,, V `40 :r ( DATE r, -� ;� t -- �j 'y' -PERMIT
LOCATION IN V 166
}} n
S. R. NO.
SUBDIVISION NAME ; ! ,/c7 LOT NO. i/I.� , ,� /,3 SECTION OR BLOCK NO.
t�
HOUSE
NO.
BUSINESS
NO. BATHROOMS
GARBAGE DISPOSAL UNIT
YES ❑
NO
[I"
AUTO. DISHWASHER
YES,[
NO
[3AUTO.
WASH. MACHINE
YES l_i
NO
❑
SITE SUITABLE
YES ❑
NO
❑
SIZE OF TANK
gal.
NITRIFICATION FIELD
sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual x&g? me
IMPROVEMENTS PERMIT BY
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
INSTALLED BY
800 Gal.
400 Sq. Ft.
800 Gal.
6 0 Scy�Ft.
90frMal":
00 Sq. Ft
1000 Gal.
1200 q. Ft.
CERTIFICATE OF COMPLETI
By Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA