P1609 Eddie Hubbardor
DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
r (Ground Absorption Sewage Disposal System - G.S. Chapter:130-Article 13C)
0WNER OR CONTRACTOR fl'DATE
/ y PERMIT
LOCATION N� 1609
S.R. NO,
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE
LE
NO. BEDROOMS
GARBAGE DISPOSAL UNIT
AUTO. DISHWASHER
AUTO. WASH. MACHINE
SITE SUITABLE
SIZE OF TANK
HOME ❑ BUSINESS ❑
NO. BATHROOMS I
YES ❑ NO ❑"
YES , ❑ NO ❑
YES NO ❑
YES 0 NO ❑
_
gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER .SUPPLY: Individual ❑ ._.Public ` ❑
IMPROVEMENTS PERMIT BY
CERTIFICATE OF COMP
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.
f.
J
J p♦
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER .SUPPLY: Individual ❑ ._.Public ` ❑
IMPROVEMENTS PERMIT BY
CERTIFICATE OF COMP
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.
f.
J
J p♦
INSTALLED BY"`/,Q•
BY' `,.��." � �`.r.`".,.r" Dates '
(8/16/73) *Construction must comply with al other applicable State and I regulations
LOT AREA .
.� ..tea...—✓'1,,--� � � �"".I
i'
� � 9
DAVIE COUNTY HEALTH DEPARTMENT D ��
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or/Site Evaluations /
NAt, E— F,Li.. t.t. - uLf'-ir r DATE ISSUED R
ADDRESS / PERMIT NO.
Explanation of charge
a—
AMOUNT DUE
T� _ SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPV'OF THIS STATEM