3179 Cornatzer Rd ' DAVIE COUNTY HEALTH DEPARTMENT
(Septic`Tank) Improvements Permit and Certificate of Completion
(Ground Aburption Sewage Disposal System --G.S. Chapter ,130-Article 13C)
OWNER .OR CONTRACTO _:r' DATE ////y/7`� PERMIT 1 r
LOCATION / Piit► t"t`�''f r�� ,.,. , ,:+ �. 6m,;t ' -, �'.. lr 9 18 ( 9
v S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS NO. 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 ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑ Q . - L,; at ✓
SITE SUITABLE YES ❑ NO ❑
SIZE 'OF TANK gal. f
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: �. �, `�y ��' J✓' /R
WATER SUPPLY: Individual ❑ Public ❑ f I 7� r
IMPROVEMENTS PERMIT BY I`��t:rt: 1.t-.�,A.j r,; INSTALLED BY
CERTIFICATE OF COMPLETION By / .G� �N• ,/ Date �!
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA