174 Manu Forti Way' DAVIE COUNTY rHEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR p y p /-C -rte' DA/TE ��- �- s — 4 -PERMIT
LOCATION D � 74 d k- i N I /A I/ y �Q i t/OC- � i-4 � Ct.lrc h NO
SUBDIVISION NAME LOT NO.
HOUSE ❑ MOBILE HOME )q BUSINESS
NO. BEDROOMS 3 NO. BATHROOMS Cx'
GARBAGE DISPOSAL UNIT YES ❑ NO ❑—
AUTO. DISHWASHER YES ❑ NO ❑c,`
AUTO. WASH. MACHINE YES 00^ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual P-ubbllick ❑
IMPROVEMENTS PERMIT BY
SECTION OR BLOCK NO.
393
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 800 Gal. 600 Sq. Ft.
Three Bedroom House 900 al. 900 Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
��
/4'" a. dQ 'r, L : Ne
INSTALLED BY
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA - 3 .�c
Q
DAVIE COUNTY~l, TH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR DATE PERMIT
LOCATION N9 393
f�
S.R. NO. f}' 3
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME{] BUSINESS ❑
NO. BEDROOMS ..: NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO 0""
AUTO.. DISHWASHER YES ❑ NO Q
AUTO. WASH. MACHINE YES Lam}" 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 . }a ✓ ?r4 t'-�+
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 800 Gal. COQ.
Sq. Ft,.
Three Bedroom House 0900 Gal- OOH a Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
t�
f
INSTALLED BY '*/"7—%)
a
CERTIFICATE OF COMPLETION
By —r, ;y j 3�i!v�i"v^�- Date
(8/16/73) *Construction must complyiviith all other applicable State and local regulations
LOT AREA ,
7