P1578 Rosewood Laner 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 �' i-0 i , , , , j ; h DATE ' �' J PERMIT
LOCATION 1 is1 - t `, .,-; { 4 ,r __�' {i. _, - � S An«,,�_ S�-i�, N? 578
S.R. NO.
SUBDIVISION NAME t x 3t°' C "a.,Y ,t LOT NO. SECTION OR BLOCK NO.
HOUSE Q MOBILE HOME ❑ BUSINESS ❑
NO. BEDROOMS z1 NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK _ b gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: �ZS�
WATER SUPPLY: Individual ❑ Public cam;
IMPROVEMENTS PERMIT BY ~;'
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CERTIFICATE OF
---------- BYE/�,-x-�.._ arc
(8/16/73) *Construction must comply with all
LOT AREA
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.
1200y
Sq.
Ft.
INSTALLED BY6-L-L
5 Date r .3
applicable State and local regulations
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DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
MOCKSVILLE, N. C. 27028 1�
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAPE� al 4 `= ag')��.� � � J{f���� - DATE ISSUED
ADDRESS -�,, • �/, S �f � �1�— PERMIT NO. iy 7k
1Ile,�4.
Explanation of charge ,,� cI-..7,f— gn,m."� (ni kjtqga�JQ
AMOUNT DUESANITARIAN ���� ►i1rl,,�r1,�
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PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
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