P1399 Cedar Grove Church RdDAVIE 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 �' a fi' r . DATE'/i:=/� l PERMIT
LOCATION t `' r ' ? 1399
c i,,f ! 'T •
S. R. NO.
SUBDIVISION NAME
LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE
HOME
g]
BUSINESS
:3
Ft.
Two Bedroom House
800
NO. BEDROOMS
NO.
BATHROOMS
GARBAGE DISPOSAL UNIT
YES
❑
NO
AUTO. DISHWASHER
YES
Q.
NO ❑
AUTO. WASH. MACHINE
YES
1200
NO ❑
SITE SUITABLEOr,
YES
❑
NO ❑
SIZE OF TANK ►
gal.
NITRIFICATION FIELD
A00
sq. ft.
DEPTH OF STONE IN LINES: X' IIvtl
House Trailer
800
Gal.
400
Sq.
Ft.
Two Bedroom House
800
Gal.
600
Sq.
Ft.
Three Bedroom House
900
Gail.
900
Sq.
Ft.
Four Bedroom House
1000
Gal.
1200
Sq.
Ft.
WATER SUPPLY: Individual ❑ Public ❑'7 1
IMPROVEMENTS PERMIT BY � f":`�'f 1 � � �'''.`��� INSTALLED BY t ,u
CERTIFICATE OF COMPLETION By � - MDate ,. -"rPj% 77
� 1 � u� —� ,
(8/16/73) *Construction must c6ply with all other applicable State and local regulations
LOT AREA PTO 'X
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