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164 Bear Creek Church Rd DAVIE COUNTY HEALTH DEPARTMENT (Septic Tank) Improvements Permit and Certificate of Completion (Ground AbsorZlzly Sewage Disposal System - G.S. Chapter 1 0- rtricle 13C) - OWNER OR CONTRACTOR ' !'/;.' e" DATE a7 PERMIT LOCATION Jt� !�i !^ .I' - 1 ? ;% �/J j�- 1r 1790 S.R. NO. SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO. HOUSE MOBILE HOME BUSINESS ❑ House Trailer 800 Gal. 400 Sq. Ft. NO. BEDROOMS ,_ NO. BATHROOMS _ Two Bedroom House 800 Gal. 600 Sq. Ft. GARBAGE DISPOSAL UNIT YES ❑ NO 0'"r Three Bedroom House 900 Gal. 900 Sq. Ft. AUTO. DISHWASHER YES ©'„... NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft. AUTO. WASH. MACHINE YES Q"� NO ❑ ' SITE SUITABLEYES [�""'NO a�r�! SIZE OF TANK CI a gal. r V NITRIFICATION FIELD sq. ft. . DEPTH OF STONE IN LINES: �.3° WATER SUPPLY: Individual ❑ Public IMPROVEMENTS PERMIT BY -- L� INSTALLED BY r CERTIFICATE OF COMPLETION By Date (8/16/73) *Construction must comply with all other applicable State and local regulations LOT AREA I / s 4a f . j DAVIE COUNTY HEALTH DEPARTMEN P. 0. BOX 57 S MOCKSVILLE, N. C. 27028 (704) X34-,59.,85 Statement for Septic Tank Improvement Permits and/or Site Evaluations NAME �+ D 5: .'DATE ISSUED psZ .ADDRESS ' PERMIT N0. Explanation of charge Zli �'a -�� �� f PIL� AMOUNT DUE 151 SANITARIAN PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.