2112 Milling Rd DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
09(Ground Absor tion Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR C. i { ltj `) DATE _ PERMIT
LOCATIO N� 1460
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
17 House Trailer 800 Gal. 400 Sq. Ft.
NO. 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 ❑ C, +4:A,,I1 L<jt rt
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN.LINES:
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY r `"' ^ �� INSTALLED BY �(�,�;, S�'• C�
CERTIFICATE OF COMPLETION ByL rnQM w Date s •'7?
(8/16/73) *Construction must omply with all other applicable State and local regulations
LOT AREA �5:>� It ay ;:
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DAVIE COUNTY HEALTH DEPARTMENT (�
P . 0. BOX 57
MOCKSVILLE, N. C . 27028
(7 04) 634- 5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
Pon
NA14E "2rrT�, �\ '-X-e (100A " DATE ISSUED "77
ADDRESS �n H�C�'ut.. �' ll `�G,.l PERMIT NO. � A
Explanation of charge�,• ,, „��
AMOUNT DUE �` �,p't) SANITARIAN q
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.