491 Cedar Creek Rd (2)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 j j- / ,s= ,.y f c�lJ DATE �}'- j/w %r, PERMIT
N° 110
LOCATION..
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE PI MOBILE HOME ❑ BUSINESS ❑
NO. BEDROOMS �NO. BATHROOMS QK-
'I
GARBAGE DISPOSAL UNIT YES ❑ NO 19
AUTO. DISHWASHER YES ❑ NO
AUTO. WASH. MACHINE YES ® NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK 91-Iry gal.
NITRIFICATION FIELD a7-,� sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY �'�►� ;*'! .;�. rt1
CERTIFICATE OF COMPLETION
BY -
(8/16/73) *Construction must
LOT AREA
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 800 a•L,,,, 600 Sq. Ft.
Three Bedroom House 00 Gal,,,..) 900 Sq. Ft.
Four Bedroom House 0(7G Ga 1200 Sq. Ft.
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14
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INSTALLED BY
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" r? ,.�^`xr4,.14 Date 't 4— //- 7
)ly with all other applicable State and local regulations
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