P1254 Cedar Creek Rd- .-
t00
DA`VIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter130-Afticle 13C)
OWNER OR CONTRACTOR. DATE /,2--3t7 " PERMIT
_ ,��f f J f LOCATION N°
`'.Cl�t �"� �t`t"' �' ��i /'�c-' 1,�.� i�7" �J�,d�l ,�'�/'�i +
S. R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE
BUSINESS
NO. BADROOMS NO. BATHROOMS ;_
GARBAGE DISPOSAL UNIT YES ❑ NO
AUTO. DISHWASHER YES ❑ NO
AUTO. WASH. MACHINE YES X NO ❑
SITE SUITABLE YES NO
SIZE OF TANK P O gal. a �/
NITRIFICATION FIELD !9!20 sq. ft.
DEPTH OF STONE IN LINES: /
WATER SUPPLY: Individual -� _Public ❑
IMPROVEMENTS PERMIT BY
CERTIFICATE OF COMPLETION
By
(8/16/73) *Construction must comply
LOT AREA J
1254
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 80 a1 600 Sq. Ft.
Three Bedroom House 00 Gal 900 Sq. Ft.
Four Bedroom House 100�0�Gal.
�" 1200 Sq. Ft.
+
SA
4win Y -C (--k,
41 /V6, ear V)j fel" /, — -.0
INSTALLED BY
Date
th all other applicable State and local regulations
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