199 Howardtown Rd DAVIE COUNTY HEALTH DEPARTMENT
- (Septic Tank) Improvements Permit and Certificate of'Completion
+R (Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)_- _ _
OWNER OR CONTRACTOR DATE r_- :: `y .J 7 PERMIT
LOCATION i•M,n ���,.Q ""4. �,:t i �� ---� 11 r. r, i _Jr N? 1473
S.R. NO.
SUBDIVISION NAME V, LOT NO. SECTION OR' BLOCK NO.
HOUSE ( MOBILE HOME E3 BUSINESS ❑
N0. BEDROOMS N0. BATHROOMS House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES [2' NO ❑ Three Bedroom House 900 Gal. 900 Sq. Ft: '
AUTO. DISHWASHER YES NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.'
AUTO. WASH. MACHINE YES ❑' NO ❑
SITE SUITABLE YES 0- NO ❑
SIZE OF TANK gal. !t
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES
WATER SUPPLY: Individual Public ❑ '�,�'�
IMPROVEMENTS PERMIT BY �.rr "��t� ,- , INSTALLED BY (id i
CERTIFICATE OF COMPLETION By � Date
(8/16/73) *Construction must co ply with all other applicable State and local regulations
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DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits ,
and/or Site Evaluations
NAME ` �� 1„ DATE ISSUED G^';Ls'-77
ADDRESS PERMIT NO. /1173
Explanation of charge 1. -J
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AMOUNT DUE �,Vb SANITARIAN f � wC►L�
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF. THIS STATEMENT.
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