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P1875 Ridge RdC * "~ DAVIE COUNTY HEALTH DEPARTMENT (Septic Tank) Improvements Permit and Certificate of Completion (Ground Absorption,Sewage Disposal System - G.S. Chapter 1_30 -Article 13C) OWNER OR CONTRACTOR `�vy L.C� �,i DATE PERMIT LOCATION �. _u ':�'i',,�n 4� 7�n'i..L ;� t - (.1 T . f• ��-tn t ��usti / 1\� 875 S.R. NO. SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO. HOUSE ❑, MOBILE HOME © BUSINESS NO. BEDROOMS NO BATHROOMS GARBAGE DISPOSAL UNIT YES ❑ NO 0, AUTO. DISHWASHER YES Q NO ❑ AUTO. WASH. MACHINE YES NO ❑ SITE SUITABLE YES ❑ NO ❑ SIZE OF TANK _ gal. NITRIFICATION FIELD sq. ft. DEPTH OF STONE IN LINES:_, �-'J 4, C L LZJ WATER SUPPLY: Individual ❑ PublicIN ❑ IMPROVEMENTS PERMIT BY Oc:Z.rt House Trailer 800 Gal. 400 Sq. Ft. Two Bedroom House 800 Gal. 600 Sq. Ft. Three Bedroom House 900 Gal. 900 Sq. Ft. Four Bedroom House 1000 Gal. 1200 Sq. Ft. a� INSTALLED BYj"cc— `" CERTIFICATE OF COMPLETION BY af2"' Date � (8/16/73) *Construction must comply with all other applicable State and local regulations LOT AREA I ..------------------- h� L DAVIE COUNTY HEALTH DEPARTMENT P. 0. B O X 57 pZa MOCKSVILLE, N. C. 27026 (7 04) 634-5985 Statement for Septic Tank Improvement Permits and/or Site Evaluations 017 � NAME � DATE ISSUED ADDRESS ,. n .� �Vz 5 PERMIT NO. ' 00 Irl . ra�1t\ Explanation of charge AMOUNT DUE i��,, SANITARIAPI PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.