392 Speer Rd DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal_Sy_stem. - G.S. Chapter 130-Article .13C
OWNER OR CONTRACTOR < U C� �'/;C Eli 7- DATE PERMIT
LOCATION �, {J r, _' / i' =' �= . ,•t. . _ ~ �. �.T N? 1602
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE El MOBILE HOME t3 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 Df Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES Qj NO ❑ Four Bedroom House 1000 Gal. 1,200 Sq. Ft.
AUTO. WASH. MACHINE YES C� . NO ❑ /l f G /ter {r �-.c. ,�.c,.:,`�.- ,n ._
SITE SUITABLE YES ( NO ❑
SIZE OF TANK 'GU gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:��`}
WATER SUPPLY: Individual �� Public ❑ .' w�
IMPROVEMENTS PERMIT BY INSTALLED BY
CERTIFICATE OF COMPLETION By .1J ��. Date
(8/16/73) *Construction must comply with ajX other applicable State and local regulations
LOT AREA
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1920
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DAVIE COUNTY HEALTH DEPARTMENT '
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
V�
� w Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME I 7C-, DATE ISSUED
ADDRESS �- PERMIT NO.
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Explanation of charge '-� ��t--� t��� �a ✓������
AMOUNT DUE ��- SANITARIAN �-•y
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATE LENT.