1119 Sheffield Rd (3) DAVIE COUNTY HEALTH DEPARTMENT
' (Septic Tank) Improvements Permit and Certificate of Completion
. +(Ground Absorp ton Sewage Disposal S stem - G S. Chapter 130-A�tic e 13C)'
OWNER OR CONTRACTORI +�;^ ..-,r,� ' �l 1 �1��%� ?�f� DATE ,� ,f,;, .r" PERMIT
LOCATION _ F y , ''�. f ,�, - ---,` - �% .� � . N° 1935
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE Ql—' , MOBILE HOME E3 BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS w NO. 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 ❑ Vii® Q''r Four Bedroom House
1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES I NO ❑ ,,..��,,
SITE SUITABLE YES ❑ NO ❑ ..-t��� tG�
SIZE OF TANK gal. ' �r
NITRIFICATION FIELD sq. ft.
�C 't i
DEPTH OF STONE IN LINES: '. � , x �'� .� f
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY ° ! ' � f INSTALLED BY
CERTIFICATE OF COMPLETION By ,, (�� r lCcl, ' /I�I�G- Date
(8/16/73) *Construction must comply with kl other applicable State and local regulations
LOT AREA
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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 DATE ISSUED
t � l-
ADDRESS ,�7-'l PERMIT N0. /
Explanation of charge
AMOUNT DUE SANITARIAN ;�77
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
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DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption ,S,ewage Disposal, System - G.S. Chapter 1 0-Article 13C)
__. ,_.
OWNER"OR CONTRACTOR' U_\C," �'' ' _0 DATE -7, PERMIT
F
LOCATION .:fit 6Jt,i.,a{ tci`` 1\� 1849
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE E 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 ❑ Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft. � y
DEPTH OF STONE IN LINES: t1�N! �
WATER SUPPLY: Individual ❑ Public ` ''
IMPROVEMENTS PERMIT BY. INSTALLED BYE -�-� _f
CERTIFICATE OF COMPLETION -'� 1 )�
gy Date /
(8/16/73). *Construction mush comply with al other applicable State and local regulations
LOT AREA
a'
Oct
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DAVIE COUNTY HEALTH DEPARTMENT orf {,Lrr�
P . 0. BOX 57 r/
MOCKSVILLE , N. C . 27022
(7 04) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAPfEC` - .� DATE ISSUED
ADDRESS Z/ PERF+!IT N0 .
Explanation of char e '4--
AMOUNT DUEL SANITARIANY2
PLEASE REtJIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEt,NT.