P81 Cornatzer RdDAVIE COUNTY HEALTH DEPARTMENT
.-.-• (Septic Tank) Improvements Permit and Certificate of Completion
(Ground.Absorp ion Sewage.Disposal System - G.S._'Chapter 130 -Article 13C)
OWNER OR CONTRACTOR r�7+R t r,l-. c; cf t : DATE PERMIT
_ /�( No
LOCATION 1 ` ...� 1.r3 _ ,rs.. .�i .>':''< •n i% yea a / :er. 7(it A;
S.R. NO.
SUBDIVISION NAME'. LOT NO. SECTION OR BLOCK NO.
Q
M
•
HOUSE 1411k, MOBILE
HOME
BUSINESS ❑
400
If
House Trailer
800 Gal.
Sq.
Ft.
NO. BEDROOMS
NO.
BATHROOMS
Two Bedroom House
800 Ga;1,
600S
..q
Ft.
GARBAGE DISPOSAL UNIT
YES
❑ NO L=1
Three Bedroom House
+,_900 Gal`s
'900
Sq
Ft.
AUTO. DISHWASHER
YES
NO ❑
Four Bedroom House
1000' -Gal.
1200
Sq.
Ft.
AUTO. WASH. MACHINE YES Q" NO ❑ r
SITE SUITABLE YES Com' NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individuals Public ❑
IMPROVEMENTS PERMIT BY INSTALLED BY r 4J "s,
CERTIFICATE OF COMPLETION
By Date C—a!
(8/16/73) *Construction must co ly with all other applicable State and local reg a ns
LOT AREA fi