1019 Pine Ridge Rd DAVIE COUNT . FA"TH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR n S
LOCATION i r c n.�. t .. t i. Cc�� A tJ ` 5
72
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S.R. N0.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer 8 Ga t.
N0. BEDROOMS . N0. BATHROOMS Two Bedroom House 800 Ga �QQ Scl,,,,
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom Hous 0 Gal. 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 gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY vac\ INSTALLED BY 'JL�j
CERTIFICATE OF COMPLETION By ���� Date " 7'��
(8/16/73) *Construction must c ply with allother applicablee• State and local regulations
LOT AREA 6
VA
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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 rL �t eC'�`r,c e: �` J'�rir'rn j�.^ DATE -��._�PERMIT
_ , n . . s
I-LOCATION572
S.RA NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME 19 BUSINESS ❑
House Trailer 8
NO. BEDROOMS c;L NO. BATHROOMS Two Bedroom House 800 Gal 600 S .
GARBAGE DISPOSAL UNIT YES El NO ❑ Three Bedroom Hous -Gal. q. 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 gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY .� INSTALLED BYia';
CERTIFICATE OF COMPLETION
BY-- �-��c�_,•-..�'� Date
(8/16/73) *Construction must c6laply with all other applicable State and local regulations
LOT AREA
�. 7 0Ab
IscXy� j( � `•