209 Kent Ln (2) 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
DATE PERMIT
1687
LOCATION N9
j
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE [:1 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 0 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 ❑ NO ❑
SITE SUITABLE YES El NO [3
SIZE OF TANK ---. gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY INSTALLED BY
CERTIFICATE OF COMPLETION
By�. Date4j��z(
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA ,h�('� ,}� '{�/���
4w
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
140CKSVILLE, N. C . 27028
(704) 634-5985 �79
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME „ ,_ , DATE ISSUED
ADDRESS ,; PERMIT NO.
Explanation of charge
ti
AMOUNT DUE � '`' SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.