112 Whitehead Drive Lot 2 Section 2DAVIE COUNTY HEALTH DEPARTMENT
of Is (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter130-Article13C)
OWNER OR CONTRACTOR ,j'" !!>�C !_�".,, , _, DATE PERMIT
LOCATION ' :1 C�i� `.J ' ;:,N.::�,t ___. n whlt�heod M •
S. R. NO.
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SUBDIVISION NAME ,, iC[ ;. L" r !".l ..LOT N0. r,J-- SECTION OR BLOCK NO.
HOUSE Q MOBILE
HOME
❑
BUSINESS ❑
NO. BEDROOMS
NO.
BATHROOMS
GARBAGE DISPOSAL UNIT
YES
❑
NO
0""
AUTO. DISHWASHER
YES
Q
NO
❑
AUTO. WASH. MACHINE
YESNO
❑
SITE SUITABLE
YES
01
NO
❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public E/
IMPROVEMENTS PERMIT BY
1932
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 800 Gal. 600 Sq. Ft.
Three Bedroom House 900 Gal. 900 Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
`y `TJ
INSTALLED BY LAI'-
CERTIFICATE OF COMPLETION IA- e_, 79
(8/16/73)
LOT AREA
By. Date
*Construction must Am -ply with all other applicable State and local regulations
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DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
MOCKSVILLE, N. C. 27028
(7 04) 634-5985 l `Q
Statement for Septic Tank Improvement Permits
and'/or Site Evaluations
NA14E ALJ DATE ISSUED
ADDRESS )WE R 14 1 T N0.��--
U n -w
Explanation of charge
AMOUNT DUE/6,
SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.