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P1999 Fork Bixby Rd
� J .. - . . �r DAVIE 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 .Da is DATE /G /6 =70' PERMIT LOCATION r09X. giX'h ./�, ( �Qo lee --%-.:ctT 41_0^1 At �'�fort M 1999 C,R-e C jt.co. S'.t,h.al . S.R. NO. SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO. HOUSE ❑ MOBILE HOME W BUSINESS ❑ e 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. DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft. AUTO. WASH. MACHINE YES ❑ NO ❑ SITE.SUITABLE YES ❑ NO ❑ Q SIZE OF TANK gal. 1 e-Ptc.c NITRIFICATION FIELDsq. ft. ?0,VL_ 56,.\ DEPTH OF STONE IN LINES: e Ta,0 T``.c►!�-%� �J ' WATER SUPPLY: Individual ❑ Public [3-- IMPROVEMENTS }-IMPROVEMENTS PERMIT BY ��"s;.. ,r'., INSTALLED BY CERTIFICATE OF COMPLETION By Date 7 (8/16/73) *Construction must comply with alf other applicable State and local regulations LOT AREA e Pl.t -TAMP, r,:.,Sr tG . �`-P~t- � �`lam a5' �'oSS�•D�� f 1� 1 v� _� .-.-'�" ► .... GAJ - y v y'f44 DAVIE COUNTY HEALTH DEPARTMENT V , P. 0. BOX 57 140CKSVILLE, N. C. 27028 (704) 634-5985 Statement for Septic Tank Improvement"LPeriri tis and/or Site Evalua.tro.ns NAME ' DATE ISSUED ( � -►©-?�'" ADDRESS,, , PERMIT NO. Explanation of charge n AMOUNT DUE SANITARIAN PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.