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P52 Yadkin Valley Rdr r 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 <f `t % ,: DATE ar - - PERMIT LOCATION Al NO 5 2 r l f. S.R. NO. SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO. HOUSE r MOBILE HOME p BUSINESS NO. BEDROOMS �' NO. BATHROOMS GARBAGE DISPOSAL UNIT YES ❑ NO ❑ AUTO. DISHWASHER YES ❑r NO ❑ AUTO. WASH. MACHINE-. YES ET".NO ❑ SITE SUITABLE YESNO ❑ SIZE OF TANK �d'� gal. NITRIFICATION FIELD I trD sq. ft. DEPTH OF STONE IN LINES: / f WATER SUPPLY: Individual ©"Public ❑ IMPROVEMENTS PERMIT BY + r CERTIFICATE OF COMPLETION BY - (8/16/73) *Construction must LOT AREA -House=-Trailer 800. Gail. 40Gi , Sq. - Ft. Two Bedroom House 800 Gal. 600 Sq. Ft. Three Bedroom House QOO Gal. 900 S Ft., Four Bedroom House 1000 Gal. 1200 Sq" -t. INSTALLED BY 0,/,,, S /, e;> :)"Cl !2&,,-A Date -2 i4- %r- ly with all other applicable State and local regulations v�