197 Dulin Rd DAVIE COUNTY HEALTH DEPARTMENT
s..._ , (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR DATE PERMIT
LOCATION. . r, 1"= !;±" r �;csr. 1'L�. N9 1964
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
Z� House Trailer 800 Gala 400 Sq. Ft.
N0. 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 L:j NO ❑ ri ��
SITE SUITABLE YES ❑ NO ❑ /! ;': '+,-�t'��•�.c „
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: ✓, ', ,�,
WATER SUPPLY: Individual ❑ Public
IMPROVEMENTS PERMIT BY INSTALLED BY (batt,,'.
CERTIFICATE OF COMPLETION Date !/
(8/16/73) *Construction must co ly with all other applicable State and 'local' regulations
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
apd/or Site Evaluations
NAME ] DATE ISSUED
ADDRESS �e-eiC& / 41/ PERMIT NO. lO
Explanation of chargeA�
AMOUNT DUE - SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT �OF THIS STATEMENT.