P1457 Redland RdDAVIE 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 DATE PERMIT
LOCATION 1457
S. R. NO.
SUBDIVISION NAME
LOT NO. SECTION OR BLOCK NO.
HOUSE p MOBILE HOME J] 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 c.�
gal.
NITRIFICATION FIELD
DEPTH OF STONE IN LINES:
■
■
■
■
sq. ft.
WATER SUPPLY: Individual �D Public ❑
IMPROVEMENTS PERMIT BY; '',
CERTIFICATE OF COMPLETION
ByS
(8/16/73) *Construction must
LOT AREA
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
INSTALLED BY C.I r R
omply with all other
.!/ Y
. 1
Date �-i7'-77
applicable State and local regulations
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DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
MOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME SrnADATE ISSUED&a /4-77
ADDRESS /u %rs. "j"5,r„�;�I� PERMIT NO. /
Explanation of charge
AMOUNT DUE # ISO SANITARIAN o
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.