395 Ridge Rd ' 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 µ DATE • '- " .� PERMIT
LOCATION i i;1 S Y fi=_�' Y. \ . ti t . . «y'!<, < f, y � NOi 1831
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS N0. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO G3— Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO [Rj'` Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO, WASH. MACHINE YES Qf- NO ❑
SITE SUITABLE YES ❑ NO ❑ 1
SIZE OF TANK gal.
c_
NITRIFICATION FIELD sq. ft. � dt;,h •
DEPTH OF STONE IN LINES: ~-
�.�( 11 -�. fir: 1 ur ��r c..n ti ; ��• �.
WATER SUPPLY: Individual Public ❑ 10,0
IMPROVEMENTS PERMIT BY INSTALLED BYJC�I/4.� ,0'T• �•
CERTIFICATE OF COMPLETION
BY Date
(8/16/73) *Construction must c mply with all other applicable State and local regulations
LOT AREA
�5
o�X 3�p
.5
(54'
fi �
�p
DAVIE COUNTY HEALTH DEPARTIMENT
P . 0. BOX 57
HOCKSVILLE, N . C . 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME ;�&„-, ,.,ATL !E�4 z, DATE ISSUED_T IJ'• -fil
ADDRESS PERMIT��.� fJ PERMIT NO. �u2, _
CL
Explanation of charge
AMOUNT DUEAA !S, 00 SANITARIAN�
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.