1781 Cornatzer Rd (3) 40 DAVIE COUNTY HEALTH DEPARTMENT �em�
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal S 's tem - G.S. Chapter 130-Article 13C)
OWNER OR CO " '% C ;�� - r..�sz DATE - `l 2� PERMIT
LOCA ON �/ f N° 493
S.R. NO.
SUBDI11S ON NAME LOT NO. SECTION OR BLOCK NO.
HOUSE En MOBILE HOME E3 BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BE ROOMS NO. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO Cn- Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO
SITE SUITABLE YES ❑ NO ❑ ''A "' r' `rvg • �`,
SIZE OF TANK gal.
NITRIFICATION FIELDS sq. ft. f� .
DEPTH OF STONE IN LINES: �p�011
/](2
WATER SUPPLY: IndividualPublic ❑ ,
IMPROVEMENTS PERMIT BYAINSTALLED BY t 1 ,�U �' '�/�• ``n\
CERTIFICATE OF COMPLETION5
Date—2_` l_ 9-S
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
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♦ L13
1