P1512 FryeDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit, and Certificate of Completion
(Ground Absc..rption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR DATE PERMIT
LOCATION N? 1512
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑' MOBILE HOME ❑ BUSINESS
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ 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: 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,t�Cii J app `Z
CERTIFICATE OF COMPLETION By Date a ��
(8/16/73) *Construction must comply with Al. other applicable State and local regulations
LOT AREA
DAVIE COUNTY HEALTH DEPARTi�ENT
P. 0. BOX 57 r
HOCKSVILLE, N. C. 27028 �\
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME ,' <-1, •.. < �� ;,, .,��� DATE ISSUED
ADDRESS .'Cc ' PERMIT NO.
Explanation of charge
AMOUNT DUE ;`Z, SANITARIAN ~,
PLEASE RE14IT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.