P1454 Hwy 801Np f` 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 j ?' _ fi' ' - DATE PERMIT.
LOCATION i , a i C,_:� ,� :t ; , ; ; , t. ..� P r,a. N° 1454
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE p MOBILE
HOME p BUSINESS ❑
"
House Trailer
800
Gal.
400
Sq.
Ft.
NO. BEDROOMS G�
NO. BATHROOMS
Two Bedroom House
800
Gal.
600
Sq.
Ft.
GARBAGE DISPOSAL UNIT
YES ❑ NO ❑
Three Bedroom House
900
Gal.
900
Sq.
Ft.
AUTO. DISHWASHER
YES ❑ NO ❑
Four Bedroom Hose
1000
Gal.
1200
Sq.
Ft.
AUTO. WASH. MACHINE
YES ❑ NO [3r'J,
-, (' • -r'i , ,�
SITE SUITABLEgt:
YES ❑ NO ❑
SIZE OF TANK
gal.
/ • - '�'
'�" L` ��
NITRIFICATION FIELD
sq. ft.
1 ? :•.��'
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual L`_J Publ�c ❑
IMPROVEMENTS PERMIT BY
c ;t`�_ ► Nll " ,-.,�1t.
v
INSTALLED BY
CERTT FI CATS OF COMPLETION ' ' V -X^" ° o
(8/16/73)
LOT AREA
BY 9 Date
*Construction must comply with all other applicable State and local regulations
.e
M D
DAVIE COUNTY HEALTH DEPARTMENT 6
P. 0. BOX 57
MOCKSVILLE, N. C. 27028
(7 04) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAPfE /{�iyi, /We -k DATE ISSUED G -/.x-77
ADDRESS AM (,V,/%/uJ J� 7.3.8 PERMIT NO. I�ZZ
Explanation of charge /— ;��-,�n.�,,9.- /1��,.�►
AMOUNT DLE�/�.da SANITARIAN
PLEASE RETIIT THE ABOVE AHOUNT ON RECEIPT OF THIS STATEMENT.