592 Baileys Chapel Rd (2)• 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 r G' DATE <i ( %fj PERMIT
LOCATION rj 1� /[ C �/ ''�';�. l �, .�.+{ . % �''{� �✓ NO 1770
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ M9BILE HOME Q BUSINESS C
NO. BEDROOMS ,/= NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO
AUTO. DISHWASHER YES Q NO ❑
AUTO. WASH. MACHINE YES 1 NO ❑
SITE SUITABLE YES [31 NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY //ern i "e"
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.
r ^,
INSTALLED BY
CERTIFICATE OF COMPLETION
Q
By- om✓ - t�GlC1f �L�-- Date
(8/16/73) *Construction must comply with a1X other applicable State and local regulations
LOT AREA
y,Y.3 X/d'
NAME
DAVIE COU�TY HEALTH DEPARTMENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank -Improvement Permits
.and/or Sj,te Evaluations
ADDRESS
Explanation of charge_
DATE ISSUED"(
PERMIT NO. /- !
r1 ., A
AMOUNT DUE ��---- SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.