P1985 Greenhill RdDAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
MOCKSVY,ILLE, N. C. 27028
(704) 634-5985
Statement for
and/or
NAME W11 C u l) C -;L
Septic Tank Improvement
Site Evaluations
A
DATE ISSUED
PERMIT NO. 17 SS'
ADDRESS
/t9aG.t'.f. o�9Q.2P'`
Permits
Explanation of charge 1-tn-+.n.uvra�.''ts,vtir.,
AMOUNT DUE /S�.tN SANITARIAN' -�
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
. -1 DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and, Certificate of Completion -
(Ground Absorption Sewage�Disposal System - G.S. Chapter 130-Art
30 Artricle 13C)
OWNER OR CONTRACTOR v k` �, t k:::. DATE 1 • I - �v� PERMIT
LOCATION \ Kr, ta� i\ S, 1 �c N? 1985
S.R., NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE @a` MOBILE HOME p BUSINESS C
NO. BEDROOMS NO. BATHROOMS %L
GARBAGE DISPOSAL UNIT YESLt1.-- 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: Individuai�� 0 Public [I
IMPROVEMENTS PERMIT BY
House Trailer 800 Gala 400 Sq. Ft.
Two Bedroom House 800 Gala 600 Sq. Ft.
Three Bedroom House 900 Gal. 900 Sq. Ft.
Four Bedroom House 1000 Gal: 1200 Sq. Ft.
6
4,Ae.1, . �. it� ,��J�3� , f - vl • 1 �x .v r7� r ,-,...:�di / ! y
INSTALLED BY
CERTIFICATE OF COMPLETIONBy-i L& Date 3 13,6 f
(8/16/73) *Construction must comply with all other applicable State and local,regu ations
LOT AREA '/c)' �� 'drot /1 ur L
z S