315 Pine Ridge Rd 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 -,J c n i r n 11 DATE �V/)-T~ ,yM PERMIT
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LOCATION l:,t�r t, �, , l� ( 6 9
'T4;1' C. S.R. NO
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS --- ----- NO. 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 ❑ h-20
SIZE OF TANK gal. Iet1
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: "
WATER SUPPLY: Individual ❑ Public ❑ ��-.� '� `"�''''' �;� ��;L ((Ii:!;. i_11,.s. . C..
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IMPROVEMENTS PERMIT BYdtt?_; 'ti �f INSTALLED BY
CERTIFICATE OF COMPLETION BY
Date 7 to
(8/16/73) *Construction must omply with all other applicable State and local regulations
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