P1824 Woodland' DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 30- Article 13C)
�. OWNE.1"OR CONTRACTOR "F&M 5414 ) `?��� ?assc-R DATE .S� �P, PERMIT
T
LOCATION /_ U7" 9C (�GiO,� /i% CCIA.^�" -�f< � L I CJ -I3 o�WoO� f'�� 1\ 1824
S.R. NO. •
SUBDIVISION NAMEpaQ�t�n,�Q LOT N0. Y SECTION OR BLOCK NO.
,Aj
HOUSE El MOBILE HOME ❑ BUSINESS ❑
NO. BEDROOMS NO. BATHROOMS Ot ! Iii
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION'FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual, ❑.. Public ❑
IMPROVEMENTS PERMIT BY
CERTIFICATE OF COMPLETION By P42� L 1
(8/16/73) *Construction must comply with a
LOT AREA
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
800
Gal.
400
Sq.
Ft.
800
Gal.
600.Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gala
1200
Sq.
Ft.
INSTALLED BY
Date l
other applicable State and loca re u ations
fro
v x x �d
1
,nn
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. Box 57 '!b1
MOCKSVILLE, N. C. 27028
(704) 634-5985 t,3y_S9S/
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME_7i,- t 'dX44.4L.� DATE ISSUED 51057179
ADDRESS �• v j�- PER14IT NO.
i
Explanation of charge 1/
I
AMOUNT DUE -J- SANITARIA
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
�f— 3b3/
DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System G.S. Chapter 130 -Article lt;E&O
OWNER, -OR PONTRACTOR --Tim 54w D � Ske�V Qg�LyQ DATE PERMIT
LOCATION Z-07" 3eA,n dS�Ail '1824
SUBDIVISION NAME \Aj oe4j ctyrj LOT NO.
HOUSE
MOBILE HOME U BUSINESS [:]NO'. BEDROOMS "y NO. BATHROOMS 6
GARBAGE DISPOSAL UNIT
YES
❑
NO
❑
AUTO. DISHWASHER
YES
❑
NO
❑
AUTO. WASH. MACHINE
YES
0
NO
❑
SITE SUITABLE
YES
❑
NO
❑
SIZE OF TANK
gal.
NITRIFICATION FIELD
sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individua L
❑.-
Public ❑
IMPROVEMENTS PERMIT BY
'':'
,{�
CERTIFICATE OF COMPLETION By 22n /f�
(8/16/73) *Construction must comply with a
LOT AREA
cfv
. R. NO.
SECTION OR BLOCK NO.
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
INSTALLED BY
Date
other applicable State and local re ulations