P196 Cornatzer Rdaj
DA IIi COUNTY HEALTH DEPARTMENT
y (Septic Tank)i Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-A ticle 13C)
OWNER OR CONTRACTOR CI'u!. C Q v�' """" DATE V - P— MI -PERMIT
196
LOCATION�:f.t7GT
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
.HOUSE t:r MOBILE HOME R BUSINESS ❑
NO. BEDROOMS ..1 NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO.DISHWASHER YES F!(NO [:3AUTO. WASH. MACHINE YES VNOSITE SUITABLE C�YESNO ❑
SIZE OF TANK J gal.
NITRIFICATION FIELD 9z"0 sq. ft.
DEPTH OF STONE IN LINES: IDS`
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY �'�' '
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
INSTALLED BY
800 Gal. 400 Sq. Ft.
1000 Gal. 1200 Sq. Ft.
S 7. a •
CERTIFICATE OF COMPLETION'
By Date^�
(8/16/73) *Construction must omply with all other applicable State and local regulations
LOT AREA
r«.w-
n