654 Cherry Hill Rd (2) DAVIE COUNTY HEALTH DEPARTMENT 1
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
,� t,OWNEROR CONTRACTORDATE PERMIT
d
LOCATION _ , . . . f ; , � et . 1934
042;—.:/Uss::/C i►. lr'?'.. ' r"".—.:' Amon" S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO..
HOUSE [+ - MOBILE HOME E3 BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
N0. 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 ❑
SIZE OF TANK }rlD gal., G "
NITRIFICATION FIELD X 3 " sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
.IMPROVEMENTS PERMIT BY %A ala Jts INSTALLED BY
CERTIFICATE OF COMPLETION By Date _79
(8/16/73) *Construction must Qsmply with all other applicable State and local regulations
LOT AREA
ti
41
2.
S
•
AV
DAVIE COUNTY HEALTH DEPARTMENT
P. -0. BOX 57 • , �Lw�'
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME We:l &W,rr e DATE ISSUED 19- ,,77-
ADDRESS
- ,,77-ADDRESS 91 PERMIT NO. 1�--
Explanation of charge /_r�r•t7Jldtiy+.> .7� a�,, - . /haus-FN
AMOUNT DUE ` SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
.-
DATE
NAME
LOCATION
r� COMMIE NTS
HOLE N0.
FINDINGS: im -
2
6 By
- _ Lot- Diagram
a�
M
' � , 14