P640 Four Corners RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground't�bsor d o Sewa e'Disposal System G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR R j � +GL) -c Moo }- -e DATEn.— .*- %7 `~ % S PERMIT
+_. �., 1 � 640
LQCAT ON �CxJ Al. + 0 /� of [�,
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SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO. ted,
HOUSE 92r MOBILE HOME ❑ BUSINESS ❑
�r•...
House Trailer
800 Gal. 400 Sq. Ft.
N0. BEDROOMS NO. BATHROOMS
Two Bedroom House
800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ �i0
(
Three Bedroom House
900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES [J'_—NO
❑
Four Bedroom House
1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES 0 --NO
❑
SITE SUITABLE YES [� O
SIZE OF TANK OOO gal.
❑
NITRIFICATION FIELD 991 a 0
sq. ft.
DEPTH OF STONE IN LINES: 9 rll►,
h,ve/v W
v PI�
'
WATER SUPPLY: Individua Public
❑
IMPROVEMENTS PERMIT BY ��
.
INSTALLED BY
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA ! tlEYQ---
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DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewa a Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR ';c-: ,q 1-1 Mr, o L -g. DATE L2=— ► J 'PERMIT
SUBDIVISION NAME
LOT NO.
HOUSE R-- MOBILE HOME ❑ BUSINESS ❑
NO. BEDROOMS _ 3 NO. BATHROOMS R`.1•..
GARBAGE DISPOSAL UNIT YES ❑ 0
AUTO. DISHWASHER YES (�"'NO ❑
AUTO. WASH. MACHINE YES � NO ❑
SITE SUITABLE YES [ANO ❑
SIZE OF TANK 0 gal.
NITRIFICATION FIELD 200 sq. ft.
DEPTH OF STONE IN LINES: _Z A", �!id✓`!'
WATER SUPPLY: Individual Ud"',^Public ❑
IMPROVEMENTS PERMIT BY
S . R / NO,
SECTION OR BLOCK NO. ,',,,` /<y
House Trailer
800
Gal.
400
Sq.
Ft.
Two Bedroom House
800
Gal.
600
Sq.
Ft.
Three Bedroom House
900
Gal.
900
Sq.
Ft.
Four Bedroom House
1000
Gal.
1200
Sq.
Ft.
INSTALLED BY
CERTIFICATE OF COMPLETION
By Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA r..
j► d
We
Ra