1246 Hwy 64W DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
�.- .j- "NGround Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR . ..C'.� F'• (o"`, y c i I t DATE _Z-,,
t7•y '7 PERMIT
LOCATIONc �-�� .�► -E cz ('� - tr-S, . P...: N9 1559
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS a NO. BATHROOMS .Z Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO •Q-_ Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES Q` NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ®" NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK ian gal. StJ Grv.�n-at �tl�elc� �v �
NITRIFICATION FIELD sq. ft. / �-ft"
DEPTH OF STONE IN LINES:
r O'
WATER SUPPLY: Individual ❑ Public '�'
IMPROVEMENTS PERMIT BY� C�!"1C�h,L INSTALLED BY
CERTIFICATE OF COMPLETION2UW oZ
By Date
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(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
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DAVIE COUNTY HEALTH DEPARTMENT V
P . 0. BOX 57
MOCKSVILLE, N . C . 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAP�'E SG�d;e �1;r�C� i � DATE ISSUED /'a?D-77
ADDRESS PERMIT NO.
Explanation of charge
AMOUNT DLE4/S o'n SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.