131 S M Whitt Dr 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 — �� 5- DATE {]-//_'7 7 PERMIT
LOCATION _ aJ�� i4��1..� / =—��r� F- . �Q,« �� I �efzr�r l�� 1493
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
N0. BEDROOMS � N0. BATHROOMS ::Z Two
Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO Q' Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES [jam NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK q W gal.
NITRIFICATION FIELD (' "1) sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public [ ;] Co 'w
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IMPROVEMENTS PERMIT BY IN TALLED BY
CERTIFICATE OF COMPLETION
ByDate 7,�.f-. 77
(8/16/73) *Construction must comp y with all other applicable State and local regulations
LOT AREA ._..
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DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57 ��7
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
` and/or Site Evaluations
NAME ,2,c h rd. bQ --L. L-,-jj" S� . DATE ISSUED
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ADDRESS 5�}, '� 3� PERMIT NO. Ur 3
r7�n C ►'S is�1��
Explanation of charge
AMOUNT DUEdSANITARIAN (�
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.