P1363 Wyo Rdt
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 DATE %- 1 "/' 7,7 PERMIT
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N° 1363
LOCATION C`
k • S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME JE j] BUSINESS
rr��
NO. BEDROOMS al NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑w
AUTO. DISHWASHER YES ❑ NO [�
AUTO. WASH. MACHINE YES Er NO ❑
SITE SUITABLE YES ❑ NO ❑
-r:-SIZE OF TANK /; 4rxTO gal
NITRIFICATION FIELD sq. ft.
h
DEPTH OF STONE IN,.LINES;° a
WATER SUPPLY: Individual) Publics ❑
IMPROVEMENTS PERMIT BY
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.
i
l L? � fj b � � �► e
INSTALLED BY
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must co6fly with all other applicable State and local regulations
LOT AREA