136 Howardtown Rd � DAVIE COUNTY HEALTH DEPARTMENT
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(Septic Tank) Improvements Permit and Certificate of Completion
(Grund Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR Boggy LAEfl-P DATE b' Q 7 PERMIT
LOCATION /I� 1� ?+',� CifCU ]` /t.r,, . r� :. l�? 1633
S.R. NO,
SUBDIVISIO NAME , ' . LOT N0. SECTION OR BLOCK N0.
HOUSE 21 MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS 3 -. NO. BATHROOMS 91 Two Bedroom House 800 Gal. �'600' Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO 93-- Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES CO NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH., MACHINE YES NO ❑
SITE SUITABLE n YES NO ❑ i1 Gy
SIZE OF TANK gal.
r
NITRIFICATION FI LD l sq. ft. w / 4
f: ? X l
DEPTH OF STONE INiLINES: RoD
WATER SUPPLY: Individual ❑ Public ❑ / .� _..�
IMPROVEMENTS PERMIT BY t INSTALLED BY
CERTIFICATE OF COMPLETION By Date / / 3 77
(8/16/73) *Construction must comply wi all other applicable State and local regulations
LOT AREA
0
c
/ter
DAVIE COUNTY HEALTH DEPARTMENT << X17 7
P . 0. BOX 57 `
MOCKSVILLE, N. C . 27028
(7 04) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME � DATE ISSUED /6 //0 7
ADDRESS � :?2 PERMIT NO.
Explanation of charge 1
AMOUNT DUE SANITARIAN Q
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STA FMENT.