382 Williams Rd DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
}(Gr,end Absorption Sewage Disposal System - G.S. Chapter ,130-Article 13C)
OWNER OR�''CONTRA %, .5,y. :#', DATE PERMIT
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LOCATION f. i i�,�w+.,� rr ..r r "� 'f'yJ�'��f ,F1 '�,` � � �` `'%t" � rlr 1804
S.R. NO.
SUBDIVISION NAME " LOT NO. SECTION OR BLOCK NO.
HOUSE 7MOBILE HOME Ej BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. 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 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE' YES GY' NO ❑
SITE SUITABLE YES ❑ NO ❑ /"{
SIZE OF TANK gal.,
NITRIFICATION FIELD sq. £t. y' mac `
DEPTH OF STONE:IN LINES:
WATER SUPPLY: Individual f",I�ii'G is
IMPROVEMENTS PERMIT BY INSTALLED BY
CERTIFICATE OF',,COMPLETION By Da-
(
(8/16/73);: *Construction must comply with all other applicable State and local regulations
LOT AREAof
�: / '
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(7 04) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME DATE ISSUED
ADDRESS PERMIT NO.
Explanation of charge
AMOUNT DUE/-'5 SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.