264 Four Corners Rd (2) DAVIE'COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal S stem - G.S. Chapter 130-Article 13C) ..
OWNER OR CONTRACTOR t1 iDATE If- („-"j `PERMIT
LOCATION �. 0 pa Co k�!I P ' N� 627
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S.R. .
SUBDIVISION NAME LOT N0. SECTION, OR BLOCK N0.
HOUSE MOBILE HOME BUSINESS ❑
House Trailer 800. Gal. 400 Sq. Ft.
N0. BEDROOMS �. N0. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ( Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES W•NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES 9-'"rNO. ❑
SITE SUITABLE YES 0-1 ❑ • d `�'T
SIZE OF TANK gal. P1rl-- "} 1SSttie a r
NITRIFICATION FIELD 7Gi . ft.
sq +
�OI.S.S a liv d.5 �tti 14—
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ( Public ❑ .
A
IMPROVEMENTS PERMIT BC INSTALMAo%lLED BY y
CERTIFICATE OF COMPLETION, BY
(8/16/73),, . *Construction must comply with all olheiyapplicable State and local regulations
LOT AREA Soo 15Q. 'F • Lv 12. 1 m.
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