4244 Hwy 801N DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal SyAtem,,-- G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR �- �" l + ` t ; %�
< < r �i .+�,,. }.:,. ,� '� .# � DATE 'r'�rf,, 7" PERMIT
LOCATION ��` ''r + - i i, !p, '! !� N� 1788
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE [}' MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS cy NO. BATHROOMS L ��- Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES Q-^ 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-T NO ❑SITE SUITABLE / YES [ NO ❑
SIZE OF TANK c!C L� gal. r"j<<<= =1`
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: �. ,., �'fc < r ° c• , '.1 .,� _ c.:;
WATER SUPPLY: Individual ❑ Public `-'
i h
IMPROVEMENTS PERMIT BY . `i' 1�� ••� `� INSTALLED BYu;,,tS .�. Cy.
CERTIFICATE OF COMPLETION By `� Date 67-
(8/16/73)
-(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
b
61 4,
r
,
i�0
49
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME _ a• h 4�ia��. - Y, ,_..a rt,- I: a DATE ISSUED
ADDRESS '7 �� �r (, �,i� PERMIT NO. ?r<�
Explanation of charge
AMOUNT DUET, (2) SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT. -