176 Cable Ln ~ DAVIE COUNTY HEALTHDEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
,ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR I"\�:,tip` ti,�,c� �,,,c DATE t1 jf+lT %� PERMIT
LOCATION �elC,r"1:rrs fii� !I t '� �n. ` 4�. fi '1� ( "�`+�i�C� i� .rn. „�? `/1 '� �� 4778
Sac ►MdG,lc 4f(rv.c. .... tc. -,;-4 S.R. NO.
SUBDIVISION NAME LOT NO. SECTION 'OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft..
N0. BEDROOMS N0. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO [2- Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO Q- Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES Lr NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ,.�
IMPROVEMENTS PERMIT BYINSTALLED. BY
CERTIFICATE OF COMPLETION
By Date a
(8/16/73) *Construction must comply with al other applicable State and local regulations
LOT AREA
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DAVIE COUNTY HEALTH DEPARTMENT � toe'
(Septic Tank) Improvements;Permit and Certificate of Completion
-(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR DATE tt `? PERMIT
LOCATION (,1r'A'- �('C ! 024ih�r ': I( 7� - �I• fi� Y`t�Ci •.n. ��? `/1 � jr�. .1 ( / 0
'ac I 4M r1 F'.IE Vl(^,.c t.. n. -} 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 G- Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO 13- Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES E!r NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES I�
WATER SUPPLY: Individual ❑ Public -.
IMPROVEMENTS PERMIT BY �. 1�.c� ,; �'� INSTALLED. BY
CERTIFICATE OF COMPLETIONa
By Date
(8/16/73) *Construction must comply with al other applicable State and local regulations
LOT AREA ,
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DAVIE COUNTY HEALTH DEPARTMENT
P . 0. BOX 57
MOCKSVILLE, N. C . 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NA14E �; a.�, '� DATE ISSUED LA & ?
ADDRESS ��,�e y� �� PERMIT NO. /77Y
Explanation of charge
AMOUNT DU1#5 tN SANITARIAN FUJ
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.