139 Applewood RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
ER OR CONTRACTOR i r/c�t..,_� r D"< -- tZ- ^ : j e— DATE 7f ".2/' t7 7 PERMIT
LOCATION Cit,,: ,_ Al 0"-1Ra,O ( 1?,t "l) - 1. i�.�� P, . t $ to .. t t ;,�' �k.i� NO
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SUBDIVISION NAME
LOT NO.
HOUSE ® MOBILE HOME 0 BUSINESS I
NO. BEDROOMS �f NO. BATHROOMS a:
GARBAGE DISPOSAL UNIT YES P�' NO ❑
AUTO. DISHWASHER YES [� NO ❑
AUTO. WASH. MACHINE YES -C'J NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK ;'J f gal.
NITRIFICATION FIELD 4-' sq. ft.
DEPTH OF STONE IN LINES: 1
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY `=`Rt*C_ N\AtAl
SECTION OR BLOCK NO.
1562
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.,_•--
CA—
INSTALLED BY
CERTIFICATE OF COMPLETION By . ' k', ". Date Z z ?7
(8/16/73) *Construction must comply with a 1 other applicable State and local regulations
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DAVIE COUNTY HEALTH DEPARTAMENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME�t..��k rr,c t`�.,.d� DATE ISSUED 7-,.R/- 77
ADDRESS PERMIT NO.
Explanation of charge_L�Q�, �� �rz:�
AMOUNT DUE /$. Vb SANITARIA14 �;� iYq
PLEASE REMIT THE ABOVE AIIOU14T ON RECEIPT OF THIS STATEMENT.