342 Salmons Rd (2) J DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion J
s
(Ground Absor tion Sewage Disposal P g p System - G.S. Chapter 130 Article 13C)
c' OWNER OR i' NTRACTOR r, .' ti::: ,; ;, . DATE PERMIT
LOCATIbN �._ •;" s :.., +'' -ii �,r 6
N
t U 1828
�
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 ❑ Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES [] NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES [P NO ❑
SITE SUITABLE YES m NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑ L ' ' ` :. j f f;�• 'r
l -
IMPROVEMENTS PERMIT BY INSTALLED BY
-T
1A A
4- 71Z
CERTIFICATE OF COMPLETION
BYDat
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
OF
70 U
i
,
--------------------
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985 , -
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME � jlG�tL �jYl��.-�..i DATE ISSUED S ��
ADDRESS f,. �/j / PERMIT NO.
Explanation of charge
A`)"
T �
AMOUNT DUE r� - SANITARIAN
PLEASE' REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.