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P1965 Baileys Chapel Rd
DA IE 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 , - <l .PERMIT f 1` _ / N° 1965 LOCATION i / tC�,� f �..1 �/` !. ? f /,,� SUBDIVISION NAME S. R. NO. LOT NO. SECTION OR BLOCK NO. HOUSE ©— MOBILE HOME ❑ BUSINESS ❑ NO. BEDROOMS NO. BATHROOMS , GARBAGE DISPOSAL UNIT YES ❑ NO C� AUTO. DISHWASHER YES ❑ NO AUTO. WASH. MACHINE YES [r NO ❑ , SITE SUITABLE YES ffr' NO ❑ SIZE OF TANK gal. NITRIFICATION FIELD sq. ft. / DEPTH OF STONE IN LINES WATER SUPPLY: Individual 0 -`Public ❑ 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 1000Gal. 1200 Sq. Ft. 171e/ INSTALLED BY CERTIFICATE OF COMPLETION Wit— r— BY Date (8/16/73) *Construction must comply with all oiher applicable -State and local regulations LOT AREA r _ l J 00, 3X1 �� .r. ,.1..,. • y--., -, • DAVIE COUNTY HEALTH DEPARTMENT P. 0. BOX 57 MOCKSVILLE, N. C. 27028 (704) 634-5985 Statement for Septic Tank Improvement Pe P P �. and/or Site Evaluations NAME %Q Axwe5- DATE ISSUED ADDRESS G � — PERMIT NO. 1r�� Explanation .of charge AMOUNT DUE SANITARIAN PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT. t