P1931 Greenwood LakesDAVIE 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 �,;-, ^;r.�? st, ii±,,�; DATE PERMIT
LOCATION _ _"6 l_ . `� LG�� E. c-�.� e ; , , i, 1�'" ;� r , 1931
S.R. NO.
SUBDIVISION NAME ,, x,A,n,e _tk!.. LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME U BUSINESS C
NO. BEDROOMS.i N0. BATHROOMS i -
GARBAGE DISPOSAL UNIT YES ❑ NO ❑'
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES [3 NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: e� of
WATER SUPPLY: Individual ❑ Public ®�
IMPROVEMENTS PERMIT BY
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.
f
,4f,�
INSTALLED BY �c .in „f
CERTIFICATE OF COMPLETION
By Date
(8/16/73) *Construction must comply with all other applicable State and local regulat" %ns
LOT AREA
47
IC9
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
MOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAPE DATE ISSUED / q
%S_ 7�
ADDRESS �-7,2y 66% , CZ::j �` PER14IT NO. /zz-—
Explana
'o -T/
AMOUNT DUE SANITARIAN
PLEASE REtdIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.