P1864 Fork Bixby Rd ~ DAVIE COUNTY HEALTH DEPARTMENT Z � L
(Septic Tank) Improvements Permit and Certificate of Co �pletion
(Ground Absorption Sewage Disposal, SystenC'- G.S. Chapter 30-Article 13C)
�`OWNE OR CONTRACTOR 1..+'f-r! `}t,{,t= ✓�^+�.., 4' r, PERMIT
LOCATION (€, ffile,
N? 1064
\.
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK-NO.
HOUSE MOBILE HOME 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 ❑� Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO: Dl
§SHWASHER ,YES (:3 NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO.. WASH.MACHINE YFS it
NO ❑ -
SITE SUITABLE YE [3 NO [3
SIZE QF,-TANK g
NITRIFICATION FIELD
DEPTH OF" STONA IN LINES:
fitT114.,
r t- r _
WATER SUPPLY: Individual 13Puiiiic ❑_
IMPROVEMENTS PERMIT BY /�/� Jc.. r Ll!�... INSTALLED BY
74
' CERTIFICATE OF COMPLETIONBy r Date `
(8/16/73) *Construction must comply with al other applicable State and local regulations
LOT AREA /()
� � r
DAVIE COUNTY HEALTH DEPARTMENT
P. 0 ' 0
B X 57
MOCKSVILLE, N. C . 270213
(704)': 63 5985 r
Statement forP P. Se tic Tank Improvement Permits
and/o Site' Evaluations
NAP?:E DATE ISSUED �9
ADDRESS PERMIT N0.
.. �70660
Explanation of charge
AMOUNT DUE SANITARIAN '
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STAT 1ENT.