P1673 WestridgeDAVIE 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 DATE :�LjLj 7e — PERMIT.
LOCATION
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1673
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE EO' MOBILE HOME U BUSINESS U
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO
AUTO. DISHWASHER YES Er NO [:1
AUTO. WASH. MACHINE YES ❑ NO 0
SITE SUITABLE YES ED' NO [3
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER -SUPPLY: Individual 0 Public Pffo
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.
INSTALLED BY
CERTIFICATE, OF COMPLETION By Date
(8/16/73) *Construction must co ply with all other applicable State and local regulations
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LOT AREA
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME r ALL, DATE
ADDRESS 'c.u-0C1, PERMIT NO.
Explanation of charge
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AMOUNT DUE- i-� SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.