P1592 Pine Ridge Rd'DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absor2tion Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR /C„ 1) Lz 2 AC DATE le) -l-0- 77 PERMIT
LOCATION c� t- P � A. ;l � t.- !r'•_k lr ? 1592
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE p MOBILE HOME
IfF BUSINESS ❑
rr
House Trailer 800
Gal.
400 Sq. Ft.
N0. BEDROOMS �D N0.
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
CD NO ❑
Four Bedroom House 1000
Gal.
1200 Sq. Ft.
AUTO. WASH. MACHINE YES
EP NO ❑,�,
• .L_ t«!1 -
SITE SUITABLE YES
M NO rl
SIZE OF TANK fy[) gal.
NITRIFICATION FIELD
sq.
ft.
A `: ,,, 11r, -y a
DEPTH OF STONE IN LINES:
p
l0�
WATER SUPPLY: Individual
❑ Public
❑
�'r�lc� ! ��'- ''
IMPROVEMENTS PERMIT BY 0frC
�� A c7
INSTALLED BY
CERTIFICATE OF COMPLETION
BY Q Date
(8/16/73) *Construction must comply with all #her applicable State and local egu ations
LOT AREA
eAW
11
.. J
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME DATE ISSUED
r
ADDRESS
PERMIT N0.
(. •+_rte.,, t' ' r�rl
Explanation of charge
AMOUNT
DUE , �� • �
SANITARIAN
PLEASE REMIT
THE ABOVE
AMOUNT ON RECEIPT
OF
THIS STATEMENT.