P1886 Howardtown RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 13 -Article 13C)
OWNER OR CONTRACTOR-��C�.,tye,✓'. DATE 7q PERMIT
LOCATION i—%b�lrrri�u /n �1� �� 1886
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE p MOBILE HOME t] BUSINESS ❑
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY ...Y
House Trailer 800 Gal. 400 Sq. Ft.
Two $edr"oom,_..House 800 Gal. 600 Sq. Ft.
Three Bedroom House'"--- ":900 Gal. 900-" Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
INSTALLED BY
CERTIFICATE OF COMPLETION eyVZ Date
(8/16/73) *Construction mus comply with all oth r applicable State and local iegulations
LOT AREA
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1
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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 -7
NAME ��� I DATE ISSUED 71/
ADDRESS PERMIT NO. �g
Explana
AMOUNT DUE
SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.