P1704 La Quinta DriveDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal rx Zn' -r/ . S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR /: • ', r<'s.r, i%!% DATE 1 1%11'7_7 PERMIT
LOCATION L i Q .t t t\! `!` Fl != t' t r 1 ! n! F'k 6 'TY NO 1704
-` S.R. NO.
SUBDIVISION NAME 11_10 6ya- I le ( _� LOT NO. SECTION OR BLOCK NO.,
HOUSE [E] MOBILE HOME BUSINESS
NO. BEDROOMS ---� NO. BATHROOMS I
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES NO ❑
AUTO. WASH. MACHINE YES EP NO ❑
SITE SUITABLE ,- YES NO [3SIZE OF TANKS gal.
!
NITRIFICATION FIELD rsq. ft.
f/
DEPTH OF STONE IN LINES: f
W_ _I- ,
WATER SUPPLY: Individual ❑ Puic ❑
IMPROVEMENTS PERMIT BY 2t:y v t'.�•:
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 800 Gal. 600 Sq. Ft.
Three Bedroom House 900 Gala 900 Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
{� 00 3
INSTALLED BY
CERTIFICATE OF COMPLETION
By
(8/16/73) *Construction must comply with all o
LOT AREA
Date—Z0 - /6 - 7i
r ap icable State and local regulations
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
MOCKSVILLE, N. C. 27028
(704) 634-5985
Statement -for Septic Tank Improvement Permits
and/or Site Evaluations
NAME ���� ����� DATE ISSUED 1112-11-17
ADDRESS
Explanation of charge
PERMIT NO.�
AMOUNT DUE_ SANITARIAN GL,.
PLEASE REMIT THE ABOVE A14OUNT ON RECEIPT OF THIS STATEMENT