P1467 Hillcrest DrDAVIE COUNTY HEALTH DEPARTMENT
�a t (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR �`i'.;'. 1. t 1 ,�,i,,., 'i.f,e DATE PERMIT
l; ; ; ! - ;, •._ N9 1467
--- - -- S.R. N0.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE Q MOBILE HOME ❑ BUSINESS C
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO 3 -
AUTO. DISHWASHER YES Q'' NO ❑
AUTO. WASH. MACHINE YES L�1NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY Individual 04 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
1000
Gal.
1200
Sq.
Ft.
INSTALLED BY
CERTIFICATE OF COMPLETIONBy e Date 111,11172
L
(8/16/73) *Construction must comply with all her applicable state and local regulations
LOT AREA
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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 rifli,k DATE ISSUED
ADDRESS �t U� b`�� D't'r►+���a P6,PERMIT N0.
Qc� uu,.,r-E. � �l • f .
Explanation of charge►'�n��r'�,�,ew,e.1s
AMOUNT DUE S,JD SANITARIAN Qp
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.