P1372 Cornatzer 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 DATE PERMIT
LOCATION ( f ; '' i , ; N° 13"7 2
-- i
I - l r F -r S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE C1 MOBILE HOME ❑ BUSINESS ❑
NO. BEDROOMS NO. BATHROOMS .
GARBAGE DISPOSAL UNIT
YES ❑
NO
-C
AUTO. DISHWASHER
YES ❑
NO
En
AUTO. WASH. MACHINE
YES eI
NO
❑
SITE SUITABLE
YES fl
NO
❑
SIZE OF TANK 1,0,0 gal.
NITRIFICATION FIELD
%d'o
sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public
IMPROVEMENTS PERMIT BY
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 800 Gal. 600 Sq. Ft.
Three Bedroom House 900 Gal. 900 Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
INSTALLED BY J)p,,. u, STT- Co .
CERTIFICATE OF COMPLETION By n �1 a Date T110 77
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
IF
4T