160 Neely Rd 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 s DATE PERMIT
LOCATION ! �F t ;4 �. U . [ ., .�i.• '' ,.4.. N9. 1459
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE n MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
N0. 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 [3 NO [3X
SIZE OF TANK 1 rD gal.
NITRIFICATION FIELD Gtru sq. ft.
DEPTH OF STONE IN LINES: /Y"
WATER SUPPLY: Individual ❑ Public ]
IMPROVEMENTS PERMIT BY .*C . f r:l,,., INSTALLED BY Z 4)
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must comply Vith all other applicable State and local regulations
LOT AREA
t
Y '
I
S
7�
DAVIE COUNTY HEALTH DEPARTMENT
P . 0. BOX 57 Owl
MOCKSVILLE, N. C . 27028
(7 04) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NA@I:E � � .�e„ DATE ISSUED/,-i7--17
ADDRESS �Cap-44- PERMIT N0 . /
Explanation of charge s A4gi [2,,,A
AMOUNT DUE�.S.0 _ SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.