P1847 Davie Academy Rd DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption S74�
Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR t.Jf�/Yf DATE t 7 PERMIT.
-LOCATION ? L01 L tic A 0-( m'l N? 1847
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME E3 BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS NO. BATHROOMS 1 Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO [`r Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO []� Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES Q" NO ❑
SITE SUITABLE YES ❑ NO ❑
X
SIZE OF TANK gal. ✓9c.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑' Public [3 ' 00
rT' �c,� f�.!/ INSTALLED B 7
IMPROVEMENTS PERMIT BYX, Y
�
CERTIFICATE OF COMPLETION B Date
(8/16/73) *Construction must'comply with all other applicable State and local regulations
LOT AREA
Fipc-
1-0
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P
i DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewagg Di posal System - G.S. Chapte_r. 130-Article 13C)
OWNER OR CONTRACTOR JAja� c/;�d7-4.�� DATE rl• ' ► 7' PERMIT
LOCATION i '. r' l\ 1847
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME C3 BUSINESS ❑.
} House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS V*f. NO. BATHROOMS t 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 ❑ .. �•{ + s
SIZE OF.TANK gal.
NITRIFICATION FIELD sq. ft. , r
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑ �. : t�_.( : ��1 ,: s.., ,� � �.
IMPROVEMENTS PERMIT BY { r+ . - i, t F"` fr INSTALLED BY
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
t
ve
DAVIE COUNTY HEALTH DEPARTMENT
P . 0. BOX 57
MOCKSVILLE, N. C . 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAY4:E DATE ISSUED 3! 7
ADDRESS PERMIT NO.
Explanation of charge
AMOUNT DUE. SANITARIAN Ali
PLEASE REMIT THE ABOVE AMOUNT„ ON RECEIPT OF THIS STATEMENT.