P910 Cornatzer Rd1 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 _ 14A.14P p r o le DATE Via'' • 47 G PERMIT
LOCATION nQ.-W �. ,`fir✓' S" hate rte."? 910
t?IVi S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME tj BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS NO. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO lam' Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO Qa" Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES [B -&'"NO ❑
SITE SUITABLE ri YES NO ❑
SIZE OF TANK IV gal.
NITRIFICATION FIELD /sq. ft.
DEPTH OF STONE IN LINES: /�t,r le"'
WATER"SUPPLY: Individual 90'0 Public ❑
IMPROVEMENTS PERMIT BY rff iot .. INSTALLED BY.� S:T• Cts.
CERTIFICATE OF COMPLETION
' By Date
(8/16/73) *Construction must c ply with all other applicable State and local regulations
LOT.AREA r
/6. 7 x 3
t