141 Raintree Road Lot 6DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground.AbsorptioYc
ewage D;10
osal System - G.S. Chapter 13 Article 13C)
OWNER OR CONTRACTOR C-cI/,
,._:-. DATE/'� 7 � PERMIT
LOCATION_ go/ r Cir�2.c R.1 -- --- �`i[ / �J�i //✓ 72& -V��'�� NU
SUBDIVISION NAME
LOT NO.
HOUSE ❑ MOBILE
HOME
❑
BUSINESS
Ft.
800
Gal.
600
Sq.
NO. BEDROOMS�—
NO.
BATHROOMS
900
GARBAGE DISPOSAL UNIT ,
YES
❑
NO
�.
L7
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 ',•
S. R. NO.
SECTION OR BLOCK NO.
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
1773
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
1 a .X3 ,av
INSTALLED BY ,
CERTIFICATE OF COMPLETION By (Zy� Date
(8/16/73) *Construction must comply with alf other applicable State.and local regulations
LOT AREA
/ /AC-
DAVIE COUNTY HEALTH DEPARTMENT
'"•I (eptic Tank) Improvements Permit and Certificate of Completion
(Ground_Absorption ewagecDi osal System - G.S. Chapter�13Article 13C).
OWNER OR CONTRACTOR C-� C Q -i DATE 5` PERMIT
� / N° 1773
LOCATI OM �O/ "" C `""i/ �n1 e. F'.. !T / / f a�
S.R. NO.
SUBDIVISION NAME tt,c. e e LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME ❑ BUSINESS I
NO. BEDROOMS _ NO. BATHROOMS
GARBAGE DISPOSAL UNIT, YES Cl NO LJ
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
CERTIFI
(8/16/73)
LOT AREA
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.
0
INSTALLED BY
OF COMPLETION By , �( Date r ( C v
*Construction must comply with alf other applicable State and local regulations
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
MOCKSVILLE, N. C. 27023
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME
u
ADDRESS
Explanation of charge_, ,,-�
DATE ISSUED cIIVZ2
PERMIT NO.,
�y
AMOUNT DU��� SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEI 0 TH TATE NT.