P1469 Ridge 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 C % ;' PERMIT
LOCATION 1469
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME ❑ BUSINESS ❑
NO. BEDROOMS d NO. BATHROOMS
GARBAGE DISPOSAL DISPOSAL UNIT YES ❑ NO EO
AUTO. DISHWASHER YES ❑, NO b
AUTO. WASH. MACHINE YES E1 NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual LJ Public ❑
IMPROVEMENTS PERMIT BY
r
House Trailer 800 Gal.
Two Bedroom House 800 Gal.
Three Bedroom House 900 Gal.
Four Bedroom House 1000 Gal.
C14 X- Y y
INSTALLED BY
400 Sq. Ft.
600 Sq. Ft.
900 Sq. Ft.
1200 Sq. Ft.
CERTIFICATE OF COMPLETION By _P,22 -7V' Date
4- 2, �Z 7
(8/16/73) *Construction must comply with 1 qj7her applicable State and local regulations
LOT AREA
MAM
0
DAVIE COUNTY HEALTH DEPARTiVIENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(7 04) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
G /P
NAME 5,�, ��DATE ISSUED (, -.&`77
ADDRESS , J �� a9.� - {} PERMIT NO. 147
[))sc ,iiL A.('. ;a7a-7—,Y
Explanation of charge (.'�„�ptvut,,1 L Qw,.,,,i
AMOUNT
DUE f j5,O
SANITARIAN
QM r)10J
PLEASE REMIT
THE ABOVE AMOUNT
ON RECEIPT OF
THIS STATEMENT.