P345 Cedar Grove Church RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Pe%wage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER' OR CONTRACTOR �"' �•ti= 7f-42 T Az; t"
DATE Y..a cl-
PERMIT
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,
345
LOCATION' :C CI + 7 t�7^: { �` `r!.
S.R.
NO.
SUBDIVISION NAME LOT NO. SECTION OR
BLOCK NO.
- HOUSE MOBILE HOME BUSINESS ❑
NO. BEROOMS NO. BATHROOMS j
House Trailer 800
Gal. 400 Sq. Ft.
Two Bedroom House Q-_Qa;..
60 Sc . F_t,.
GARBAGE DISPOSAL UNIT YES ❑ NO ErThree
Bedroom House OQ,,G.U�
00 Sq. Ft)
---AUTO. DISHWASHER YES ❑ NO ❑'+.
Four Bedroom House 1000
Gal. 1200 Sq. Ft.
AUTG_. WASH. MACHINE YES ❑ NO ❑'�.
SITE SUITABLEYES [ NO ❑
SIZE OF TANK Sc. gal.
K '1
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:y,x,,.��"
Public ❑
WATER SUPPLY: Individual Ar
IMPROVEMENTS PERMIT BY,. 1k t' . l Cs�"��•�=� �"+•a
INSTALLED BY �''ar'.ti WI F .
S '7r' Gb
CERTIFICATE OF COMPLETION. BY a �{ ti� .� Date
(8/16/73) *Construction must-"Shmply with all other applicable State and local er gulations
LOT AREA
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