1461 Ridge Rd DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-,Art cle 13C)
OWNER OR CONTRACTOR l..<i.•;1 f~!C c./1� DATE �- /% ,% PERMIT
LOCATION __ if N? 1904
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 ❑ NO o-*- Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES 0'' NO5.
❑ //�r '' % "' f
SITE SUITABLE YES ❑ NO ❑ (�
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑ (�
IMPROVEMENTS PERMIT BY ��; 1 i )67,,: ,SIJ INSTALLED BY
CERTIFICATE OF COMPLETION By ) Date 7( ( 1?
(8/16/73) *Construction must comply with gfl other applicable State and local regulations
LOT AREA
f
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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 L Cf �ire�f.. DATE ISSUED 7�
ADDRESS r/ �f / PERTSIT N0.
Explanation of charge �,r��� ,,•�_
AMOUNT DUE /5 ,� SANITARIAN
PLEASE REMIT THE ABOVE AHOUNT ON RECEIPT OF THIS STATEMENT.