P1487 OJ HartDAVIE 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 ^ t- DATE %' 7_ PERMIT
LOCATION �7.j;.� ; r.. N? 1487
S.R. NO. ty-w�ca
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME ❑ BUSINESS ❑
NO. BEDROOMS ' NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES I NO ❑
AUTO. DISHWASHER YES,[�. NO ❑
AUTO. WASH. MACHINE YES t_1 NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK -13.5'0 gal.
NITRIFICATION FIELD /5 cD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual,. d Public ❑
IMPROVEMENTS PERMIT BY
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
s:
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
INSTALLED BY
CERTIFICATE OF COMPLETION/
By M n^^ Date 4//-1-7/7d-
(8/16/73)
i-7?d- -
(8/16/73) *Construction must Vomply with all other applicable State and local regulations
LOT AREA o` �i.� 75' i( 3 •(•
Q "P -u/
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Im roy ment Permits
and/or Si e Eval�O ! 7
NAME /% % �� ✓ 7%7 / 7
V• �%/l! DATE ISSUED
ADDRESS �7 Z3 X - 3 P i T NO. ' -
wiw � �DE -t
Explanation of charge
r Y Y
AMOUNT DUE ` SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.