P1884 Rock House Rdt •
DAVIE COUNTY HEALTH DEPARTMENT
r (Septic Tank) -Improvements Permit and Certificate of Completion
O(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNEOR CONTRACTOR ��,, t %`1.•sf,�i s ., ; �.y DATE _ PERMIT
LOCATION , ; f ` j 7 . e.e +4 ,- Gr% j� F.:. ..E .r i .. ; . N9 1884
i S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE 0' MOBIL:
NO. BEDROOMS
GARBAGE DISPOSAL UNIT
AUTO. DISHWASHER
AUTO. WASH. MACHINE
SITE SUITABLE
SIZE OF TANK
NITRIFICATION FIELD
HOME ❑ BUSINESS
BATHROOMS f
N0.
YES
❑
NO
YES
❑
NO
YES
Q1
NO
YES
❑
NO
_ gal.
sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY ba,, tt
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.
INSTALLED BY
CERTIFICATE OF COMPLETION
By Date �
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
f
0
DAVIE COUNTY HEALTH DEPARTIPENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME 'fit; ������-�%�'� DATE ISSUED 7 �O
ADDRESS
, ( PERMIT NO.
Explanation of charge �- L G.�_ c ,- /L-:>•"��
AMOUNT DUEZS. - SANITARIAN �
PLEASE REMIT THE ABOVE A110 NT ON RECEIPT OF THIS STATEhi NT.