667 Greenhill Rd DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion =
(.;round Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER;;OR CONTRACTOR _ - . _ DATE PERMIT
LOCATION +�, - '_ J r `;: N9 1484
# S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ .'^ MOBILE HOME BUSINESS ❑
* ` f • � House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDRObMS 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 �y YES ❑ NO ❑ •k r i i; 'ti '`
SIZE OF TANK 7 dy gal. F
NITRIFICATION FIELD 6,00 sq. ft. � � C
DEPTH OF STONE IN LINES: g l'da.rTY
WATER SUPPLY: Individual ❑ Public ❑ _
IMPROVEMENTS PERMIT BY INSTALLED BY
t�-
CERTIFICATE OF COMPLETION7
By ~�1 raM r ` Date /S 7
(8/16/73) *Construction must cgmply with all other applicable State and local regulations
LOT AREA
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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 R(A,,1ll �. (�,��,,a,� DATE ISSUED 7-6-7?
ADDRESS PERMIT NO. J�7`
Y,Y\" k-S
Explanation of charge j G : f,--tA.'A
AT;OUNT DUE , SANITARIAN
PLEASE RE14IT THE ABOVE AMOUNT 014 RECEIPT OF THIS STATEMENT.