P1913 Ijames Church RdHOUSE p MOBILE HUMS
DAVIE COUNTY HEALTH DEPARTMENT
N0. BEDROOMS _� N0.
(Septic Tank) Improvements Permit and Certificate of Completion
House Trailer 800 Gal. 400 Sq. Ft.
^ (Ground
Absorption Sewage Disposal System - G.S.
Chapter 130- rticle-13C)
GARBAGE DISPOSAL UNIT YES
OWNER OR
CONTRACTOR s/'G!l't`' _ /r!f('
DATE 2�
PERMIT
LOCATION
AUTO. WASH. MACHINE YES
NO ❑
1913
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ann"'. Jrt+tcfr'% r7 /r f i .1 7+'7
%ani' J S.R.
NO.
SUBDIVIS
ON NAME LOT N0.
SECTION OR
BLOCK NO.
j
HOUSE p MOBILE HUMS
U BUSINESS
N0. BEDROOMS _� N0.
BATHROOMS_
House Trailer 800 Gal. 400 Sq. Ft.
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 House 1000 Gal. 1200 Sq.•Ft.
AUTO. WASH. MACHINE YES
NO ❑
SITE SUITABLE YES
_NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD
Sq. ft.
j
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual
❑ Public ❑
IMPROVEMENTS.PERMIT BY ,
,lf'
INSTALLED BY'Oq}
CERTIFICATE OF, COMPLETION
B
Date
(8/16/73) *Construction must comply with all
othe'.applicable State and local regulations
LOT AREA
6A F
..
,�'
J�
' DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57 -
MOCKSVILLE, N. C. 27028
3(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAMIE DATE ISSUED
ADDRESS PERMIT NO. T
Explanation of charge
AMOUNT DUE 8o SANITARIAN f�Y
.PLEASE REMIT THE ABOVE AMOUNT ON'RECEIPT OF THIS STATEMENT.
f-