415 Country Lane Lot 26� 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, ' �1l i.' i_, } f t. 'J' "r r'� Vis/ DATE ` i?,% PERMIT
"
LOCATION 1618
r.;c` �/ � �� %�' L= - N •
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME . ❑ BUSINESS 1
NO. BEDROOMS NO. BATHROOMS �---
GARBAGE DISPOSAL UNIT .YES ❑ NO Q'
AUTO. DISHWASHER YES [] NO ❑
AUTO. WASH. MACHINE YES NO ❑
SITE SUITABLE YES. NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
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.
'!{-� J�
INSTALLED BY W4
CERTIFICATE OF COMPLETION Bye/J% Date
(8/16/73) *Construction must comply with all other applicable State and local' regulations
LOT AREA. /+ S I R y lda"i�
o- V
DAVIE COUNTY HEALTH DEPARTMENT �0'� V,
P. 0. BOX 57 (j
140CKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME/`/ DATE ISSUED
ADDRESS PERMIT N0. /
Explanation of charge
AMOUNT DUE SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEIMENT.
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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
NAME C �0. .4 � ,..; ; DATE ISSUED
ADDRESS '� �- PERMIT N0.
AMOUNT DUE a SANITARIAN --7-77,
PLEASE REMIT THE ABOVE A14OUNT ON RECEIPT OF TH S STATEMENT.