P1751 Deadmon Rd " 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 tk rf.a 'f rI C a`T._ DATE $ C>
LOCATION
1751
SUBDIVISION NAME '' LOT NO. SECTION OR BLOCK NO.
HOUSE Q MOBILE HOME E3 BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS -'' NO. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES Cl NO 0'J 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 gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
777
~/
WATER SUPPLY: Individual ❑ Public ❑ r � �. R f a
IMPROVEMENTS PERMIT BY INSTALLED BY
CERTIFICATE OF COMPLETION. By Date Z
(8/16/73) *Construction must comply withal oth applicable State and local regulations
LOT AREA.
J�
t
_ n ,
DAVIE COUNTY HEALTH DEPARTMENT
P . 0. BOX 57 3 l L5 (((
MOCKSVILLE, N. C . 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and//or Site Evaluations
NAPS: / C� �f DATE ISSUED
ADDRESS PERMIT NO. ' ,
Explanation of charge
AMOUNT DUE lJ� SANITARIAN �-
PLEASE REMIT THE ABOVE A140UNT ON RECEIPT OF THIS STA EMENT.