484 Riverdale Rd _ DAVIE COUNTY HEALTH DEPARTMENT
= - IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION- --
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name Date
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House r ~� Mobile Home _ Business Speculation
No. Bedrooms --j No. Baths =-~ No. in Family
Garbage Disposal YES ❑ NO E]--
Specifications for System:,.
Auto Dish Washer YES O NO ❑ - 1
Auto Wash Machine YES p NO ❑ '� y r
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
—J4
Improvements permit by
*Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by
r'
Certificate of Completion ' �'�^� � Date//
*The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation;but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
` DAVIE COUNTY HEALTH DEPARTMENT
(Septic`Tank)'Improvements Perttiit-Arrd'Certi€icate g�of Completion
`r(Ground Absorption Sewage Disposal_ System - G.S. Chapter 13 -A ,
rticle"T3C
-OWNER OR CONTRACTOR UN N 4-N g N t Y COC DATE Q l L 7 PERMIT
LOCATION R 1y ii-� l21 r'i,. t= RD ~ o t Z ..iQ N? 1615
S.R. NO.
SUBDIVISION NAME '' ),OT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME C3 BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
N0. BEDROOMS N0. BATHROOMS 3 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 E!''. NO ❑ ti
SITE SUITABLE YES NO ❑
SIZE OF TANK 900 gal. /
NITRIFICATION FIELD sq. ft. Q Q U t
k �
DEPTH OF STONE IN LINES:
t
WATER SUPPLY: Individual ❑ Public ❑ C2 5 0
IMPROVEMENTS PERMIT BY 3Q" INSTALLED BY
CERTIFICATE OF COMPLETION
By Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
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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 .,t +i�j DATE �J Ft: ,� �� PERMIT
LOCATIONS i V E: i7:-t 1 �= +;3? (, t .N ,!" 4 . ,.Ff >i t ,(- N? 61
' S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE [) MOBILE HOME E3 BUSINESS ❑
a House Trailer 800 Gal. 400 Sq. Ft.
N0: BEDROOMS NO. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO Er 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"y' NO ❑
SITE SUITABLE YES (3" NO ❑
SIZE OF TANK q00 gal. 11
NITRIFICATION FIELDsq* ft. � . a
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑ -� '''r`'`
IMPROVEMENTS PERMIT BY eINSTALLED BY
CERTIFICATE OF COMPLETION
By Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA '
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DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57 q a
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank . Improvement Permits
and/or Site Evaluations
NAME _ 't `^ DATE ISSUED !
7
ADDRESS L4 , P ;Pj j A. J j PERMIT NO.
Explanation of chargee
4-
AMOUNT DUE _ SANITARIAN"
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
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