500 Hillcrest Dr DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR j ki' PERMIT
DATE
LOCATION 1756
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 El NO 0." Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES CD NO 0 Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES C NO 0
SITE SUITABLE YES C,f NO
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft. L
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual 0 Public El
IMPROVEMENTS PERMIT BY 1,1 INSTALLED BY
CERTIFICATE OF COMPLETION By Dat
(8/16/73) *Construction must comply with all ther applicable State and local' regulations
LOT AREA
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DAVIE COUNTY HEALTH DEPARTMENT
P . 0. BOX 57
MOCKSVILLE, N. C . 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME iL•GZc; DATE ISSUED S
ADDRESS PERMIT NO .
charge_
of
Explanation / ►7'i i -G�' '��" ' � � rGL
P
1 �
AMOUNT DUE / �- SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.