129 Cable Ln DAVIE COUNTY HEALTH DEPARTMENT &ble-
(Septic Tank) Improvements Permit and Certificate of Completion .
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER-RR CONTRACTOR *0L.'-s( r',., DATE - v 7P PERMIT
LOCATION `l.��:..�'' �ct�,c 1`:�� 'i �"'. , A s`?�1 ! ri' tc >ws iC'. ► N° 1789
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S.R. N0.
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 Gala 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO Three Bedroom House 900 Gal. 900 Sq. Ft.
r'AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑. _
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft. ly� = x��,.: � c� (/♦
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ . Public T"
IMPROVEMENTS PERMIT BY , INSTALLED BY
=F11 /177
CERTIFICATE OF COMPLETION
BY Date
(8/16/13) *Construction must comply with alf other applicable State and local regulations
LOT AREA
1\ ( 1
I)
1
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028 i
(704) 634-5985 ! 2-
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME �Ae """`Q' DATE ISSUED
ADDRESS PERMIT NO. l7?�?
Explanation of charge
AMOUNT DUE CN SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.