P1470 EC JarvisDAVIE 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
LOCATION N? 1470
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE El MOBIL:
NO. BEDROOMS
GARBAGE DISPOSAL UNIT
AUTO. DISHWASHER
AUTO. WASH. MACHINE
SITE SUITABLE
SIZE OF TANK
HOME ED BUSINESS
NO.
BATHROOMS
YES
El
NO
YES
C3
NO
YES
❑
NO
YES
❑
NO
- gal.
1000
■
■
■
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual 13 Public
IMPROVEMENTS PERMIT BY INSTALLED BY
CERTIFICATE OF COMPLETION By 1�
(8/16/73) *Construction must C
LOT AREA
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
I f Y\tLl- ,, Date -7 1 1 - ? 7
Ay with all other applicable State and local regulations
E�3
I
DAVIE COUNTY HEALTH DEPARTIMENT
P. 0. BOX 57
MOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NA10E E.0. 3, DATE ISSUED &-,23-77
ADDRESS �� ��{ �,� PERMIT NO. J �t %p
MacIle A . e. a76a�!
Explanation of chargeI
AMOUNT DUE Jam.rT, SANITARIAN -do
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.