143 Wendell Ln DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter ; 90-Article 13C)
OWNER OR CONTRACTOR rj ''1'- jr� y ? r;' %; i`,i DATE /j��s" ' �f� PERMIT
LOCATION
(,. •,;.4 i,->,; �: S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME tj BUSINESS ❑
} Fi House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS '""J NO. BATHROOMS r Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO Q� 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 ❑ �,; jy
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑
,
IMPROVEMENTS PERMIT BY �e� ,; ;•�� <-��•`(,� INSTALLED BY �� %=
CERTIFICATE OF COMPLETION
By �' -G�..•..��f, %�� ;���i-s r •�- Date �/��..�
(8/16/73) *Construction mus comply with a 1 other applicable State and. local regulations
LOT AREA
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DAVIE COUNTY HEALTH DEPARTMENTL�J
P . 0. BOX 57
MOCKSVILLE , N. C . 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
,� ,til-i�L�� ,;�� (,�✓i .,� /�S
NAPE _ DATE ISSUED
ADDRESS �' /7,� G� PERMIT NO .
Explanation of charge
AMOUNT DUE /J • SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.