1233 Howardtown Circle (2) T
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 I ; t#'� i t.'+ r l =i e' �f DATE %>,I�;j PERMIT'
LOCATION
;F• ,,, NU 1635
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
F House Trailer 800 Gal. 400 Sq. Ft.
N0. BEDROOMS NO. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO 0°"" Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000 Gal, 1200 Sq. Ft.
AUTO. WASH. MACHINE YES Q NO ❑
SITE SUITABLE YES ❑- NO ❑
SIZE OF TANK ,` si gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ lublic ❑
IMPROVEMENTS PERMIT BY ' INSTALLED BY
CERTIFICATE OF COMPLETION
By Date
(8/16/73) *Construction must o p y w t 'alfrother applicable State and loca :.e at ons '
LOT AREA
10
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T
DAVIE COUNTY HEALTH DEPARTMIENT
P . 0. BOX 57 ell
MOCKSVILLE, N . C . 27023 4
(704) 634-598S
Statement for Septic Tank Improvement Permits 16t I//??
and/or Site Evaluations
f1
NAPI:E ,--h Cc4A,4,4 DATE ISSUED
ADDRESS�T� p, �_ PERMIT NO .
IVO - 2, 702-J
Explanation of charge
A1i0L'NT DUE1 1 SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STA EMENT.