954 Point 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 i/1,i r :"%'r''t. <:% DATE - j, ; !j� r PERMIT
LOCATION fr : : 1 ;r l r l� 1642
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS
NO. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
Three Bedroom House 900 Gal. 900 S
GARBAGE DISPOSAL UNIT YES ❑ NO ❑� q• Ft.
AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES 0 NO ❑SITE SUITABLE YES ❑ NO
SIZE OF TANK /i gal.
NITRIFICATION FIELD sq. ft. r}J -,ex
DEPTH
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY /i f.,.� ti , r`; ._> INSTALLED BY �^ r /,
CERTIFICATE OF COMPLETION
�•
BY Date
(8/16/73) *Construction must comply wi-t a 1 o her applicable State and loca �Ions
LOT AREA
`�'�k1 Al
DAVIE COUNTY HEALTH DEPARTMENT
P . 0. BOX 57 r�
MOCKSVILLE, N. C . 27028 V
(704) 634- 5985
Statement for Septic Tank Improvement Permits
/I and+/or Site Evaluations
NAME L°���� '"� DATE ISSUED '/0/3I f� r
ADDRESS �t'�-'�y PERMIT NO .
i � 1 :.,i�~;^-�_•.-.mac--Y'�� .�/l/!/'t,�
Explanation of charge )
AMOUNT DUE •.S• SANITARIAPI
PLEASE REMIT THE ABOVE AHOUNT ON RECEIPT OF' THIS STATEME T.