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129 Brookedale Drive Lot 9 Section2DAVIE COUNTY HEALTH DEPARTMENT (Septic Tank) Improvements Permit and Certificate of Completion (Ground Absorptio Sewage Disposal System - G.S. Chapter 130 -Article 13C) OWNE .OR CONTRACTOR Ec 13 DATE %� PERMIT 6D LOCATION ale N° 1777 t!•A. a\V• SUBDIVISION NAMELOT N0. SECTION OR BLOCK NO, HOUSE Ef MOBILE HOME ❑ 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 2' Three Bedroom House 900 Gal. 900 Sq. Ft. AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft. AUTO. WASH. MACHINE SITE SUITABLE YES ❑ YES ❑ NO ❑ NO ❑ %©Q SIZE OF TANK gal. NITRIFICATION FIELD sq. ft. DEPTH OF STONE IN LINES: }( �j X a WATER SUPPLY: Individual ❑ Pub l c� [D BY IMPROVEMENTS PERMIT BY INSTALLED CERTIFICATE OF COMPLETION By�Aal� (8/16/73) *Construction must comply with a LOT AREA eDate /` other applicable State and local regulations C-3- O/i �. j G _ (Qi 1 M V1 X� a� DAVIE COUNTY HEALTH DEPARTMENT R P. 0. BOX 57 HOCKSVILLE, N. C. 27028 (704) 634-5985 Statement for Septic Tank Improvement Permits and/or Site Evaluations NAME �,4 „ L��r,,s /� � � DATE ISSUED (� , ADDRESS i'G PERMIT NO. �' w n Explanation of charge Ar4OUNT DUE_ SANITARIAN PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMEN . a NAME Use 0�1 • DAVIE COUNTY HEALTH DEPT. PERK TEST RECORDS DATE d044,( 0— LOCATION LOCATIOtJ ,�1zce� ur - =`' ,$rz��✓oGiw-�i COMMENTS FINDINGS: HOLE NO.1 HOLE NO.2 HOLE N0. 11 p rn°" BY Cl�i J LOT DIAGRAM