1084 Salisbury 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 CONTRACTORDATE
PERMIT
1"7'76
LOCATION '- N?
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS -21 NO. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO a- Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO Q" Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES 0— NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal. 'C 7;3 -.r' iry: /,
NITRIFICATION FIELD sq. ft. i`;"�_` � Ye, �
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY ';, . `_.� _ :. A,> INSTALLED BY
CERTIFICATE OF COMPLETION
y ���^ �' Date
(8/16/73) *Construction mu comply with all ther applicable State and local regulations
LOT AREA
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DAVIE COUNTY HEALTH DEPARTHIENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME N `7Arti% C4- DATE ISSUED 7�
ADDRESS j?.f,,fe- y PERP-SIT N0. /77(
Explanation of charge
AMOUNT DUE ,llU SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
DAVIE COUNTY HEALTH DEPT.
PERK TEST RECORDS
DATE �P.r.1�, i91?
NAME
LOCATION
FINDINGS: HOLE N0.1 COMMENTS��u"f��n .h. --� tamwT;,r.
HOLE NO.2 �`I` / �Jrv�,n -� 1 ® ►�;,�
HOLE NO. 3 4 ' �� :h l�t�,►r,:�
BY �Clir
LOT DIAGRAM �49
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