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236 Clark Rd DAVIE COUNTY HEALTH DEPARTMENT �..�. . (Septic Tank) Improvements Permit and Certificate of Completion (Ground Absorption�Sewag� Disposal pyst % - G.S. Chapter 13,0-Article 13C) OWNER OR CONTRACTOR ,4. c,d'�^�t.�% � ��%�,!r,,:s� DATE r, / ERMIT LOCATION _ �/ 1579 .,`/? ,,�`?�I�r r , il.r.. .f�. `� `..>'! `!� ♦i .d-. ,,'?". .i'`"i,.>_ ",.,..Qd.-l...y iA•s /,VS.R. 0. SUBDIVISION NAME '''� `Y LOT�k. SECTION OR BLOCK NO. HOUSE MOBILE HOME BUSINESS ❑ House Trailer 800 Gal. 400 Sq. Ft. N0. BEDROOMS t 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 ❑ NO SITE SUITABLE • YES }*' NO ❑ SIZE OF TANK t gal. NITRIFICATION FIELD sq. ft. DEPTH OF STONE IN LINES: WATER SUPPLY: Individual Pu lic ❑ IMPROVEMENTS PERMIT BY 9.G�^�1�'�'OJ INSTALLED BY �,/rr � xp�,, .Tr ��i,1L CERTIFICATE OF COMPLETION 0C Date (8/16/73) *Construction mus comply with all other applicable State and local regu a if ons LOT AREA / x y �l M r 1 r \ ,vf v f � q 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 NAPE `:i� DATE ISSUED '`,� �� ADDRESS ^%./,� Q' ,C1,L' ../�f .,� PERMIT N 0 . Explanati�n of charge,11.44!--W,��;;�,�r .f �f AMOUNT DUE SANITARIANr•y �''fl„� � f PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.