P1713 Speaks RdCERTIFICATE OF COMPLETION ���
By Date
(8/16/73) *Construction must comply wi h al other applicable State and local egu ations
LOT AREA
DAVIE 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 /Z Z, il,, iii-` DATE
PERMIT
LOCATION i ` ;.t.+ • �. r i "!� ''• / 4i
N?
1713
- - S.R.
NO.
SUBDIVISION NAME LOT NO. SECTION OR
BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer 800
Gal. 400
Sq. Ft.
NO. BEDROOMS NO. 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 ❑ NO Q
Four Bedroom House 1000
Gal. 1200
Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO b
SITE SUITABLE YES ❑ NO 0
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: ,;
15
WATER SUPPLY: Individual_,_ ❑ Public ❑
\
IMPROVEMENTS PERMIT BY !/r<. � . ! ��� �L"� .!�
INSTALLED BY �1/l� 1 ..C�c�ai�
� 7'
Z ,
CERTIFICATE OF COMPLETION ���
By Date
(8/16/73) *Construction must comply wi h al other applicable State and local egu ations
LOT AREA
13.2
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57 /}/Z
MOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and//or Site Evaluations
NA14E (/T�/' DATE ISSUED
ADDRESS}G %,j ����i PERMIT N0.
?(jig
Explanation of`. charge
AA40UT DUE SANITARIAN
PLEASE REMIT THE ABOVE A14OUNT ON RECEIPT OF THIS STATEMENT.