708 Cornatzer Road Lot 1DAVIE COUNTY HEALTH DEPARTMENT
Aw'(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR W „ DATE o�a Io PERMIT
�1 N° 1164
LOCATION t �a � :� P,`�' z �' r"' 1 � t� +�
S.R. NO.
SUBDIVISION NAMEC II,a & '.R4 -t i.tic,, LOT NO. SECTION OR BLOCK NO.
HOUSE
BUSINESS
NO. BEDROOMS ^�6 NO. BATHROOMS
GARBAGE DISPOSAL UNIT
YES
❑
NO
❑
AUTO.
DISHWASHER
YES
❑
NO
❑
AUTO.
WASH. MACHINE
YES
❑
NO
❑
SITE
SUITABLE
YES
❑
NO
❑
SIZE
OF TANK C{ TO _ _
_ gal.
NITRIFICATION FIELD &00 sq. ft.
DEPTH OF STONE IN LINES: av 1C x( &,+
WATER SUPPLY: Individual 19 Public ❑
IMPROVEMENTS PERMIT BY
CERTIFICATE OF COMPLETION -
BY—
(8/16/73) *Construction must
LOT AREA
House Trailer
800
Gal.
400
Sq.
Ft.
Two Bedroom House
800
Gal.
600
Sq.
Ft.
Three Bedroom House
900
Gal.
900
Sq.
Ft.
Four Bedroom House
1000
Gal.
1200
Sq.
Ft.
INSTALLED BY
- yy\OjnnL Date ! (J- 7� Y • ?
ly with all other applicable State and local regulations