P1978 Hwy 801NDAVIE COUNTY HEALTH DEPARTMENT
14 qty+ (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage D_is psal System - G.S. Chapter 1 O-rticle 13C)
09NER OR CONTRACTOR eZ 7/1G•Yl .C�' !/ S DATE /heY PERMIT.
LOCATION N° 1978
_ _-/�_� 1 '"" d N ,%� t � d%'%1 .e"/�/'/i�l�/GI J? ( fi � I i�
S.R. N0.
.UBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME E3 BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
N0. BEDROOMS N0. BATHROOMS �` Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO [T Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES V---XN
❑NO Qo ' Four Bedroom House •1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES0SITE SUITABLE ` YES O ❑ ? ��
SIZE OF TANK` V gal. / _o Ira
NITRIFICATION FIELD sq. ft. s
DEPTH OF STONE IN LINES: (.l,
WATER SUPPLY: Individual Public ❑ �j-
IMPROVEMENTS PERMIT BY �C.�, INSTALLED BY
CERTIFICATE OF COMPLETION
By
_(8/16/73)' *Construction must comply wit
LOT,AREA
y ' / U • Date 311V2 9
all ther applicable State and local regulations
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27.028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and=e Evaluations
NAiHEA DATE ISSUED
ADDRESS 0 PERMIT NO.
yV .
Explanation of charge
..--,
ADIOUNT DUE `' SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
DAll lr CCJF'TY HE-ALTH D;-rT•
PERCOL'T?Ch Tr -
ST ESTL TS
DATE-!/-%�'
NAME C� L 1 \• S
LOCATION