P954 Pinebrook DrDAVIE 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 ,� �� �"F, r DATE PERMIT
LOCATION 't r "" / . ' `? . r .. � � .. ,''., . N09 9-54,
S.R. NO.
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SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
N0. BE 00 S NO..BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES I NO ❑ ree-S—ed room House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES NO ❑ our ed room mHHouse 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES Q, `90 [3!' '' ; ivx ,' - f� ��
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SITE SUITABLE t - YES 12--, 0 ❑ -r
SIZE,OF TANK gal.
i NITRIFICATION FIELD
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DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑ _ `,,
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IMPROVEMENTS PERMIT BY , _ ,� .t y'.� INSTALLED BY
CERTIFICATE OF COMPLETION
By
(8/16/73.) *Construction must c
LOT AREA' `
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Date
with all other applicable State and local regulations