7704 Hwy 801S (2)_ -DAVIE COUNTY .HEALTH DEPARTMENT ��V 0
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter .130-Article 13G)
OWNER OR CONTRACTOR �'�P:.r!.'' ,���r `�iI, PERMIT
' ,.,fit ii' DATE _, �T �+
�OC TION _ h` / I'i%1/���'r7i. f ;iz%'�' �/ �; Ott-ls/,��r : f' ,s, 1\ ? 1 U 9
NO.
SUBDIVISION NAME LOT N0. SECTION OR BLOCK NO.
HOUSE MOBILE HOME'Ej BUSINESS. ❑ t
,�' House Trailer 800 Gala 400 Sq. Ft.
N0. BEDROOMS _ NO. BATHROOMS i? ! Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ N0 2 Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES E3N0 Ea_,Four.Bedroom'House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES. IEJ--90 ❑ "
SITE SUITABLE YES 93--09'0 ❑ 1, "
SIZE OF TANK eu ti) gal. ! ; l r •��'�?'
NITRIFICATION FIELD -s . ft.�
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual'- ❑ Public
IMPROVEMENTS PERMIT .BY :l:?`� INSTALLED BY
CERTIFICATE OF COMPLETION By. ! ' Date
(8/16/73) *Construction must comply.with all er applic le. ate and local regulations'
LOT AREA
7
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
MOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
a d/or Si a Evaluations /
NAME � DATE ISSUED
ADDRESS PERMIT NO.--
.E?,yYL�iC J /
Explanation of charge
to
AMOUNT DUES SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.