2626 Farmington Rd }
DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 30-Article 13C)
OWNER OR CONTRACTOR fit' / , '/E;:/¢ � DATE ; PERMIT
LOCATION r ;'�;s . s l �t ;j .� f' `K ,./ j " 1861
. ,-'.c / ta'
'fit F f. S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
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 P NO ❑ ys
SITE' SUITABLE YES M NO ❑ C1/ �� 'G�t� /lt�
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft. �►+ , �' f
DEPTH OF STONE IN LINES•
WATER SUPPLY: Individual ❑ Public 's /�5 0 X-3x 111,,,,Cl
IMPROVEMENTS PERMIT BY -';f%.•,{/� INSTALLED BY
CERTIFICATE OF COMPLETION By / y �) fl �� Date oln �� 7
(8/16/73) *Construction must comply with al other applicable State and local regulations
LOT AREA It
75- X-3 y
DAVIE COUNTY HEALTH DEPARTMENT
P . O. BOX 57
MOCKSVILLE, N. C . 27023 fA
4 6 5 /70 ,�rb
(70 ) 4-593
3
Statement for Septic Tank Improvement Permits
and/or SitelEvlluations
NAVE UL° ��fv Gil' DATE ISSUED
i
ADDRESS � ` 1)g0r d— PERMIT NO .
Explanation of charge_
,y
AMOUNT DUE `. SANITARIAN. ,,
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.