P743 Daniel RdDAVIE 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- �, ,�-a DATE j+� _;•,Z „. as PERMIT
LOCATION
S. R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME JZ BUSINESS ❑
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES C NO ❑
SIZE OF TANK 60 gal. '~
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: 1,J I'
WATER SUPPLY: Individual Q Public ❑
IMPROVEMENTS PERMIT BY
CERTIFICATE OF COMPLETION
By
(8/16/73) *Construction must'comp
LOT AREA
ffm
743
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom HouseI Ga f) T6 -6O Sq'. _V
lt
Three Bedroom House 1900 Gal.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
E
INSTALLED BY
rte'«-G"GI Date//—
with all other applicable State and local regulations
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