179 Twin Cedar Golf Rd DAVIE COUNTY HEALTH DEPARTMENT
`' e tic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR _' ,,; E,� ,.��� DATE /�, . : ,. 7 PERMIITT
LOCATION , Io,t "' (` # 1\ 773
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE IR 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 ❑
SITE SUITABLE YES [3 NO ��'�
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft. v -
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual CR,, '•Public ❑
IMPROVEMENTS PERMIT BY , ,, 1 INSTALLED BY
CERTIFICATE OF COMPLETION By Date l l"ao"M'
(8/16/73) *Construction must omply with all other applicable State and local regulations
LOT AREA
4111
. � d _. .