P150 Pine Ridge RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements -Permit-and , Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNEWWitOR • CONTRACTOR— ,., t -- i iPERMITDATE
N° 150
LOCATION
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE .M MOBILE HOME ❑ BUSINESS
NO. BEDROOMS NO. BATHROOMS c` -
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE ,} YES ❑ NO ❑
SIZE OF TANK j' it o gal.
NITRIFICATION FIELD x4;r0 sq. ft.
DEPTH OF STONE IN LINES: Z� `r
WATER SUPPLY: Individual X Public ❑
IMPROVEMENTS PERMIT BY ��i', "M?
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 6a.L F00-.Sq,..•,..Ft,;
Three Bedroom House 9 900, Sq. >
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
INSTALLED BY it_ _.
CERTIFICATE OF COMPLETION
BY Date `..
(8/16/73) *Construction must SMFy with all other applicable State and localre`gul;lftons
LOT AREA
r � /
4
f
r b
l 1.