647 Gladstone Rd DAVIE COUNTY, HEALTH DEPARTMENT
„• (Septic Tank) Improvements'Permit and Certificate of Completion
(Ground Absorption Sewage DisposanlSystem - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR 'rf;.}its, ,'1-U a,t Y _� DATE 10 jam' PERMIT
LOCATION � l�1:..tP .�F. ; �71i1, (�.�.« r�.: ,z�, ^fi" f _ ,. tc % P JRA : N° 1944
S.R. NO.
SUBDIVISION NAME LOT N0. SECTION OR BLOCK N0.
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
N0. 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 ❑ NO ❑
Ae
SITE SUITABLE . YES [3NO c3t r E L'�-- .V. r� �'.`
SIZE OF TANK -gal.
NITRIFICATION FIELD sq.- ft.
DEPTH OF'STONE IN 'LINES:
tt s J_
WATER SUPPLY: Indiw`i�dt3a1 Public ❑ J;` .r.F�r,,f 1 ! :°-•;ra ,�``�pY
IMPROVEMENTS' PERMIT'BY INSTALLED BY v
CERTIFICATE OF COMPLETION
-kin Date
(8/16/73) *Construction-�must' i;omply with all other',applicable Sta a and local regulations
LOT AREA
-�f.d'� \ ,• ,.,� ry" �.w.r ny.. .a w'w.ww+ruN.w..-'..r.rr»r++.4+��e'
f) i.-✓PYA'-'Y, l! r.y . )
- h.M. ' J �.-•� � l •,� j,.' :'l `mo""""b.'•.: - .. '
w DAVIE COUNTY HEALTH DEPARTMENT
P . 0. BOX 57
MOCKSVILLE, N. C. 27028
• (7.04) 634-5985 "7T/ter
---- -- - - r
•_ _ __ ___ Statement._ for -Septic-Tank- m
Improveent -Permi- ts j
- and/or Site Evaluations
NAME - 4L,::�A� DATE ISSUED 0
ADDRESS r
fJ• C0 PERMIT N0 .
Explanation of charge
AMOUNT DUESANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STA MENT. '�