P1447 Doug WallDAVIE 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 - DATE PERMIT
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LOCATION r , , , ! � �> r; .. 1447
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR'BLOCK NO.
HOUSE ❑ MOBILE HOME ❑ BUSINESS ❑
NO. BEDROOMS ' NO. BATHROOMS +�
GARBAGE DISPOSAL UNIT YES ❑ NO Q
AUTO. DISHWASHER YES Cj" NO ❑
AUTO. WASH. MACHINE YES [5 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
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�,•a. S: (• Ccr
CERTIFICATE OF, COMPLETION By Date /c- s- 77
(8/16/73) *Construction must lomply with all other applicable State and local regulations
LOT AREA
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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 �Ut/q tug// DATE ISSUED .5--31-77
ADDRESS PERMIT NO.
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Explanation of charge I- ',rnp ,„ye
AMOUNT DUE cS•lJv SANITARIANSktfilz-04
PLEASE RE14IT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.