P1768 Angell RdDAVIE 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 PERMIT
N? 1768
LOCATION
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS ❑
NO. BEDROOMS = NO. BATHROOMS House Trailer 800 Gal. 400 Sq. Ft.
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 C NO ❑
SITE SUITABLE YES EM NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
is
'
WATER SUPPLY: Individual [j Public
IMPROVEMENTS PERMIT BY INSTALLED BY
CERTIFICATE OF COMPLETION By D
(8/16/73) *Construction must comply with all other applicable State and local reguiations
LOT AREA
HEALTH
DAVIE COUNTY hEALTH DEPARTMENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/ r S' to /E/:valuations 7
NAME DATE ISSUED
-?/
ADDRESS r � i ✓> d-� �,i-PERMIT NO.
Explanation of charge /
AMOUNT DUE I'S, � SANITARIAN )/�'L,/� `
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMEN .