226 Four Corners 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 s ` .:P ' DATE PERMIT
96._. >
LOCATION
�M
' S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE [Jy 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 0- Three Bedroom House .;900-6a i "1 900 Sq. Ft.
AUTO. DISHWASHER YES NO ❑ Four Bedroom House 1000aT: 1200 Sq. Ft.,,
AUTO. WASH. MACHINE YES NO ❑
SITE SUITABLE YES [}'" NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.?
DEPTH OF STONE IN LINES: Z
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY INSTALLED BY p A/
CERTIFICATE OF COMPLETION
BY m Date?__ — 5
(8/16/73) *Construction must owith a 1 other applicable state and local regulat2ions
LOT AREA+ - ....