214 Parker Rd (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
LOCATION 1972
S.R. NO.
SUBDIVISION NAME f LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS 0
I 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 0' Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES [:3 NO []-' Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ED NO
t_k
SITE SUITABLE YES NO
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public rl
Z
IMPROVEMENTS PERMIT BY INSTALLED BY I
CERTIFICATE OF COMPLETION A
By 44� Date"�u
(8/16/73) *Construction must comply w"ft'fi 'ali ,Other applicable State and local, regulations
LOT AREA
f
DAVIE COUNTY HEALTH . DEPARTMENT
P. 0. BOX 57 L� `
MOCKSVILLE, N. C. 27028 /
(704) 634-5985
Statement for Septic Tank ' Improvement Permits
I and/or Site Evaluations
NAME DATE ISSUEDof
ADDRESS _�, j l jU PERMIT NO.
f
Exp 1 a n a t i o n of charge
AMOUNT DUE SANITARIAN � � .�-
PLEASE REMIT THE ABOVE AIIOU14T ON RECEIPT OF THIS STATEME�