3990 Hwy 601S DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(GVound Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR ' , ',r '�:. C, . DATE PERMIT
LOCATION J,:niC_ �m �' rr,. �', lr� 1594
A S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS . NO. 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* gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑ r
IMPROVEMENTS PERMIT BY INSTALLED BY ! - 7,0-'—&C .
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
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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
NA14E �?,f�-�i�. �L/fir=��r'i2� DATE ISSUED r-::jn-77 PERMIT NO. 1-79
Explanation of charge
AMOUNT DUE`1. rlI) SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT SOF THIS STATEMENT.