P1882 Ijames Church Rd - .4tificate of Completion
•
z - S. Chapter 130-Article 13C)
'OWNEOR. C DATE `T 1 PERMIT
rw .Y +
LOCATIO =s,l +'� »� �.t�+ c i.,,7 ��, Lcd� { l.t,r. �t_[�-,a�xi 1000
ct.4-t S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
-HOUSE Q 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 ❑— Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. 'DISHWASHER YES ❑ NO ❑ Four Bedroom House .'1000 Gala 1200 Sq. Ft.-
AUTO. WASH. MACHINE YES NO ❑-
SITE SUITABLE YES ❑ NO ❑ '
SIZE OF TANK gal. �1. Cf� 1-.L
NITRIFICATION FIELD sq. ft. J I:
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ' 0 'Public ❑ ,,.,/�//�>
IMPROVEMENTS PERMIT BY '�-J( �t, ' INSTALLED BY � T LC/ •
CERTIFICATE OF COMPLETION
BY Da
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA i r s4-
c
V
DAV I E COUNTY HEALTH DEPARTMENT � 6 Ld �
P. 0. BOX 57
HOCKSVILLE, N. C. 27028 �� N
(704) 634-5985
Statement for Septic Tank Imp vement Permits .�
and/or Site Evaluation
NAME ` 4 Al A A „ , DATE ISSUED
A —
DDRESS �� PERMIT NO.
® 1114 4.4 4 414� �n I u
xplanation of charge
F”
AMOUNT DUE�� SANITARIAN .
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEN NT.