253 Ratledge Rd DAVIE COUNTY HEALTH DEPARTMENT
a:• %' (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter P0- rticle 13C) 2
OWNER'OR CONTRACTOR .r-!,;, DATE ,, PERMIT
LOCATION .V v i /_5 i, �' / /'��+^' /+ /f 1\ • 1981
R 1
-rx S.R. NO.
SUEIAI ISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE Eli.--- MOBILE HOME E3 BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS- NO. BATHROOMSTwo 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 Eg,"NO ❑
SITE SUITABLE YES ❑ NO ❑ j �--,! ,fir
SIZE OF TANK gal.
NITRIFICATION FIELD sq* ft. s7
DEPTH OF STONE IN LINES: �
WATER SUPPLY: Individual ❑ jPublic ❑ T �,
IMPROVEMENTS PERMITBYt `" ` _ INSTALLED BY '
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must comply with allot er applicable Stateandlocal regulations
LOT AREA
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10
DAVIE COUNTY HEALTH DEPARTMENT
P. iO. BOX 57
MOCKSVILL.E, N. C. 27028
(704) ,634-5985
Statement for Septic Tank Improvement Permits//
and/or Site Evaluations1�
NAME Z°/` DATE ISSUED I7/�
ADDRESS PERMIT NO. .
Explanation of 'charge
AMOUNT DUE !=� SANITARIANS .
PLEASE REMIT THE ABOVE AHOUNT ON RECEIPT OF". THIS STATEMENT.
DAV TE- CCU?.'TY HEALTH 0[PT ( -
PERCOLATION TEST RESULTS
DATE LIQ/
NAME a-sf� y
LOCATION / ,
UMME NTS
10
EIf4DINGS• � "� �/
/40
17
671 4 /, �Q
6 BY
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