201 Kennen Krest Rd DAVIE COUNTY HEALTH DEPARTMENT 10
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Ar icle 13C)
OWNER 0 CONTRACTOR-.�`c`.r;, �o -) " PERMIT
DATE .: a 7
LOCATION `�1�'r�o�ri�l�"'� r - .• �.��'�,:';:l^ 0'. 4:'F1 \ { 'c ��u� C.�,..� - N? ( J5
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SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
N0. BEDROOMS a NO . BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ 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 ❑ oa-�-
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: S\ 5�.•�\� - �a tY+v.Q � 1�" t?cck 1 t u t
WATER SUPPLY: Individual ❑ Public Sep\;c'�Ahk�c�rT\raiC� ,tom Ca?1 \�,�tbc.�NF
IMPROVEMENTS PERMIT BY ?C?. �'1ran�r+arJ INSTALLED BY
CERTIFICATE OF COMPLETION
BY Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
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DAVIE COUNTY HEALTH DEPARTMENT
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(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
r-OWNER OR CONTRACTORDATE PERMIT
LOCATION ' v- N . 1795
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.,•,c S.R. N0.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME Ej 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 ❑ 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 ❑ ,.�_., ` :;CN,, x k,:,%,
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
{
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: ctti: <• 1�sst..� _ +tiJ s�•_n{ ��, �. tom;" :ycek I4u(:
�Gi�x .�� ...... �cc 11 �qi.x.,.:C �• Vic:i c+i
WATER SUPPLY: Individual ❑ Public LL-1—
IMPROVEMENTS
a.-.IMPROVEMENTS PERMIT BY INSTALLED BY
CERTIFICATE OF COMPLETION
By Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
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DAVIE COUNTY HEALTH DEPARTMIENT y v
P . 0. BOX 57
MOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAMEDATE ISSUED "013'74
ADDRESS �� -Uk J�yeS\c3Wr� ya PERMIT NO. ��►� 5
Explanation of charge - „t,,,�
AA70UNT DL'E ,$cJ� SANITARIAN
PLEASE REMIT THE ABOVE AlIOU14T ON RECEIPT OF THIS STATEMENT.