128 Raintree Road Lot 27DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorpt ewage Assp,olal S em G.S. Chapte 130- rt
OWNER OR CONTRACTOR -1�� f P1=—%y W�/ DATE
LOCATION Xt//
SUBDIVISION NAME
HOUSE ❑ MOBILE HOME U BUSINESS
0 lr<-e,.-U�
le 13C)_,
PERMIT
N° 1868
S.R. NO.
LOT NO. SECTION OR BLOCK NO.
CERTIFICATE OF COMPLETION By
(8/16/73) *Construction must comply with
LOT AREA
Date -a
1 other applicable State and local
ons
House Trailer 800 Gal. 400
Sq. Ft.
NO. BEDROOMS NO.
BATHROOMS
Two Bedroom House 800 Gal. 600
Sq. Ft.
GARBAGE DISPOSAL UNIT YES
❑
NO ❑
Three Bedroom House 900 Gal. 900
Sq. Ft.
AUTO. DISHWASHER YES
❑
NO ❑
Four Bedroom House 1000 Gal. 1200
Sq. Ft.
AUTO. WASH. MACHINE YES
SITE SUITABLE YES
❑
❑
NO ❑
NO ❑�d
.(% GZt�avyl
SIZE OF TANK gal.
NITRIFICATION FIELD
sq. ft.
t /r
i
DEPTH OF STONE IN LINES:
Aw-
WATER SUPPLY: Individual
❑
Public �❑
,,)SI
� �S�l,Cev,"
IMPROVEMENTS PERMIT BY ' ff �"
�''>!:-' -�,i,
INSTALLED BY���
CERTIFICATE OF COMPLETION By
(8/16/73) *Construction must comply with
LOT AREA
Date -a
1 other applicable State and local
ons
' DAME :.COUNTY • HEALTH DEPARTMENT
('Septic `Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage_Disposal'S G.S. Chapter 130 -Ar cle 13C).
OWNER OR CONTRACTOR , �ta:t.f �: / DATE Cr/; % PERMIT
LOCATION.'. c;lc 4/+�- Nom. 1\ O
1868
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK N0.
HOUSE . ❑ MOBILE HOME ❑ BUSINESS [
NO. BEDROOMS NO::BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH.,MACHINE YES. ❑ NO ❑'
SITE SUITABLE YES. Q NO ❑
SIZE.OF TANK gal-,
NITRIFICATION FIELD sq.,'
q. ft.
DEPTH OF STONE. IN LINES s)
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 Gala 900 Sq._Ft.
Four Bedroom -House 1000 Gala 1200 Sq. Ft.
INSTALLED BY
r
r
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
MOCKSVILLE, N. C. 27028
(7 04) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NA1:E DATE ISSUED
ADDRESS PERMIT NO.
Explana
AMOUNT DUE SANITARIAN_()all,, -
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.