219 Southwood Drive Lot 1, 2 + 11 Section Cti4 DAVIE, COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorp on ewag Disp/ sal ystem - G.S. Chapter '130 -Article 13C)
OWNER OR CONTRACTOR DATE DATE _TTL��7 / 7 y7 PERMIT
LOCATION CUA thyl,
NO. BEDROOMS NO. BATHROOMS'
GARBAGE DISPOSAL UNITYES ❑ NO ❑
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_ ❑ Publico ❑
IMPROVEMENTS PERMIT BY.
(8/16/73) *Construction mus£ comply
LOT AREA
House Trailer
800
Gal.
400
SUBDIVISION NAME LOT NO.
SECTION OR
BLOCK NO.
800
Gal.
NO. BEDROOMS NO. BATHROOMS'
GARBAGE DISPOSAL UNITYES ❑ NO ❑
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_ ❑ Publico ❑
IMPROVEMENTS PERMIT BY.
(8/16/73) *Construction mus£ comply
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.
INSTALLED BY .i:// {(-ID,.
Date
applicable State and local/ r g 1 tio:
gid.
/ a/� 3K
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 , /zl"r/'r 5 DATE PERMIT
LOCATION \41A 7� lnC9h! t2� S f YYAcLOv-N�li 1�i� N9.
SUBDIVISION NAME
LOT NO. SECTION OR BLOCK NO.
[tUU,L U
numt
U
WhINNSJ
d�MMUDILL
Ft.
Two Bedroom House
800
'fes
NO. BEDROOMS yJ
NO.
BATHROOMS
Three Bedroom House
900
GARBAGE DISPOSAL UNIT
YES
❑
NO
❑
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 a ,_
(8/16/73) *Construction must comply with 1
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.
INSTALLED BY �,P
Date "
applicable State and local
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
MOCKSVILLE, N. C. 27028
(704) 634-5985 "
Statement for Septic Tank Improvement Permits
f ,� ��a`nd/or Site Evaluations,
'7
NAME- f= —�'- �C/ u[. 6wtss�C DATE ISSUED ( 7
ADDRESS �1�N�-f`�L�f /V ' PERMIT NO. �7
Explanation of charge
AMOUNT DUE SANITARIAN
PLEASE.REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMEAT..,
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 {� �� Q� fLUa y,,c t?ih.44.o) DATE ISSUED_// ,�
-_r - - - /
ADDRESS /,;, c�aw.00,, /j/, PERMIT N0./go_
Explanation of charge_
AMOUNT DUE SANITARIAN��
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF 'THIS STATEMF T.
�-o'�'-G4-l-Z-�1 `�LuaC�6 Hrrcr�-rc�a/uA
`DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No,e
' of Bedrooms 7 T Date
This permit is granted to � S./ for the installation of a septic tank_
at the residence of Address �>b4Y33 mc/ s ✓T/
Building Contractors 2A Address
Septic Tank Specifications: Length Width Depth Capacity Gal. f®
Manufacturer's Name Bad Address
No, of lines / width_in. Total Length o o ft. No. of q. Ft. /ZOO
om
Type of .filteerr'materiaTotal tons used
Minimum Requirements: House T ailer Tank Cap. 800 Sq. ft. line / 400
Two-bedroom house 800 600
Three-bedroom house 900900
r r r / o" / X,00
No one shall install a septic tank in Davie County without a permit from the Health Officer
or his agent. (yam 6
Date of final approval �5 6�7 Signed:`
Sanitarian
I hereby certify that the above septic tank has been installedaccordingto specifications.
peso a 7�4 W uac/ �r : ,,t T Signed: lam. �,//
pp n V Septic Tank Contractor
/I Q k W. Nt .... . .
Note: Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksville.