168 Howardtown Rd w
s: 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 CONTRACTOR r' r> DATE PERMIT
LOCATION 1708
1 S.R. N0.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
N0. BEDROOMS N0. BATHROOMS House
Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES El NO LJ�, Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES C3 NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑SITE SUITABLE YES CI NO ❑ ', �^
SIZE OF TANK :'iJ gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: ,
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY ; : . s. INSTALLED BY
CERTIFICATE OF COMPLETION
By Date
(8/16/73) *Construction must comply with all other applicab a State and local regulations
II � / .
LOT AREA - - [.11NL' r I ���I��C S
J
A1t.
i
4
t %i'
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
DATE ISSUED
ADDRESS I/` /'�� .i S PERMIT NO. 17e
10
Explanation of charge P/1
r �
AMOUNT DUE �J, �^ SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STA mENT.