758 Pine Ridge Rd DAVIE 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 (s1 i J� DATE /G — -.f PERMIT
LOCATION _-t'; R� #� =1 .¢_ rh .it -. "T-: .l�_ 4>< .t,l •;_•..� 1�- I� ` i 1 N? 758
P145-r REQ. 1e% S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sqz.
N0. BEDROOMS _ N0. BATHROOMS Two Bedroom House 600 .S�F�
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House 14�Ca -. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000. Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Q Public ❑
IMPROVEMENTS PERMIT BY _o b INSTALLED BY i, S•-t-•4�.
CERTIFICATE OF COMPLETION
gym\���n0� Date
,(8/16/73) *Construction must mply with all other applicable State and local regulations
LOT .AREA
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26
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