610 Four Corners Rd (2) DAVIE COUNTY HEALTH DEPARTMENT
(Septip Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage,, Disp al System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR "`rt I- � DATE,'! �" I '. PERMIT
LOCATION AlnC7, ,'. tJl �:.. a/ lr 912
Ci • r I." AO E- ! !,7 .R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
�*s House Trailer 800 Gal. 400 Sq. Ft.
N0. BEDROOMS .,F'ri N0. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑, 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 ❑
SIZE OF TANK rll.' gal.
NITRIFICATION FIELD eCuj#Vsq. ft.
DEPTH OF STONE IN LINES: � # !
WATER SUPPLY: Individua )r 13-1`ublic ❑
IMPROVEMENTS PERMIT BY 1M INSTALLED BY •w.
CERTIFICATE OF COMPLETION By Date G'1
(8/16/73) *Construction must 4mply with all other applicable State and local regulations
LOT .AREA �^
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