907 Yadkin Valley Rd (2)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 L�� . DATE - ; v' PERMIT c
LOCATION 1 j v r` „•.« a". .` _.. �1- 2 U 1
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE .OR MOBILE HOME ❑ BUSINESS ❑
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ['
AUTO. DISHWASHER YES ❑' NO ❑
AUTO. WASH. MACHINE YES Ca'' 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 -• -!:
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 80Q—Ga 600 Sq. Ft_
Three Bedroom House(' 900 Ga gIS Sq. FO
L -
Four Bedroom House 'lOd"� Gal. 1200 Sq. Ft.
INSTALLED BY S '"T, CO i
CERTIFICATE OF COMPLETION By G.iv�s�i Date l0 - /o ^74
(8/16/73) *Construction must 6mply with all other applicable State and local regulations
LOT AREA