P1539 Seaford Rd DAVIE COUNTY.HEALTH DEPARTMENT � V
;(Septic. TankYIzn ovements.°Pernut 'and Certificate of Completion
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r' ,(Grouia'Absorpf on Sewage Disposal' System ,- G.S." Chapter 13'0- r•ticle 13C)
OWNER OR CONTRACTOR j
� 3t. ' '
DATE: '' PERMIT i
LOCATI ON a l\ 15 3 9 r
fs. 1
„ . S.R. N0._
SUBDIVISION NAME „T •LOT NO., SECTION "OR BLOCK NO.
HOUSE- MOBILE HOME E3 BUSINESS-0
s:. House Trailer 800 Gal., 400: Sq ' Ft.
NO.- BEDROOMSNO. BATHROOMS
Two Bddroom House 800 'Gal. 600 Sq. Ff.
_.f 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 ❑
Y ;SIZE OF TANK gal.-:- r 4
s, .
. . NITRIFICATION .FIELD sq. V.
DEPTH OF ;STONE IN LINESs .
WATER SUPPLY:' Ind'irv-ibual ❑ Public . ❑ A ,
IMPROVEMENTS PERMIT -BY ` INSTAWb BY �e
CERTIFICATE. OF COMPLETION
BY j Date
;(8/16/73) *Construction must comp y wit all other appl b'le State and loca regJeal 6ns
-LOT AREA
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DAVIE COUNTY HEALTH DEPARTMENT
P . 0. BOX 57 � -
MOCKSVILLE, N. C . 27028
---�__. 704 634-5985
Statement for Septic Tank Improvement Permits
and/or Site EvaluationsJA t -y
NAP/:E -• DATE 'ISSUED
ADDRESS CXR 1 PERMIT NO. �5 3
r
Explanation of ch rge I
AMOUNT DUE ) �d � SANITARIAN —
b
PLEASE REMIT THE ABOVE AMOUNT, ON RECEIPT OF THIS STATEME
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