P1636 Howardtown 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 h�rn�c, ItI�f;:/E,r.�. DATE /t')-/,40`-77 PERMIT
LOCATION _ ;.. .. . �-M . ../ N° 1636
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE [L-- MOBILE HOME Ll BUSINESS
NO. BEDROOMS NO. BATHROOMS /`r
GARBAGE DISPOSAL UNIT YES
❑
NO
0—
AUTO.
DISHWASHER YES
('f
NO
❑
AUTO.
WASH. MACHINE YES
900
NO
❑
SITE
SUITABLE YES
❑
NO
❑
SIZE
OF TANK liv gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: d4"(tv4j
WATER SUPPLY: Individual ❑ Public1-1
❑
IMPROVEMENTS PERMIT BY �'�{ , �- ter, ,..,- S c,
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 -/L
INSTALLED BY
i
CERTIFICATE OF COMPLETION ByP
Date
(8/16/73) *Construction mustFcomply with all other applicable State and local reg lations
,r
LOT AREA
i1
`t
,5,t ��// p ,
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
MOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME gU( ,,,i 61 I<e,Tv-, DATE ISSUED
ADDRESS tRv,, C- 3 PERMIT NO.
Explanation of charge Q_a.,��.�'�"'
AMOUNT DUE SANITARIAN Ci.
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.