356 Spillman Rd (2)DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
x (Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR" CONTRACTOR ' =' f DATE PERMIT
1
LOCATION N° 1527
:� . ( ,, -: �- i r,,_ ., , � i;"y ;.
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE
NO. BEDROOMS
LE HOME 0 BUSINESS
GARBAGE DISPOSAL UNIT
AUTO. DISHWASHER
AUTO. WASH. MACHINE
SITE SUITABLE
SIZE OF TANK
NO. BATHROOMS
YES ❑
NO
E
YES ❑
NO
Q"
YES ❑
NO
❑
YES D
NO
❑
_ ga 1.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: 1%
!,,(-i
WATER SUPPLY: Individual S Public ❑
IMPROVEMENTS PERMIT BY
CERTIFICATE OF COMPLETION
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 -�c �� Ta—le i .a -
BY / Date
(8/16/73) *Construction must comply with all ther applicable State and local regulations
LOT AREA
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(7 04) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME ��,;��;Q �c�Q r0 DATE ISSUED
ADDRESS PERMIT NO. /.Sa 7
fYlot�su�ll�
Explanation of charge
AMOUNT DUE 15"a SANITARIAN F�cl_K
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.