1922 Hwy 601N (2) 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 DATE;', ''` ; PERMIT l�
LOCATION t-i . ? 1483
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME 0 BUSINESS
House Trailer 800 Gal. 400 Sq. Ft.
N0. BEDROOMS 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 'UU gal.
NITRIFICATION FIELD Usq. ft. '''
DEPTH OF STONE IN LINES: c.�
WATER SUPPLY: Individual ❑ Public
IMPROVEMENTS PERMIT BY INSTALLED BY
CERTIFICATE OF COMPLETION By- � f 1�,,tr. f�
Date
(8/16/73) *Construction must c�mply with all 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/, /--7/
ADDRESS .� PERMIT NO. I t1 <2
f i uC_s
Explanation of charge
AMOUNT DUE
J`��" SANITARIAN ,
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.