P1515 James Brownt...l�► * DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorpt�i n Sewage Disposal System.- G. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR ,J� h�cS . )(.� DATE PERMIT
LOCATION N?,; ; 1515
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS NO. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE, DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER. YES ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
.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 INSTALLED BY
CERTIFICATE OF COMPLETION 3 D Sl
BY Date
(8/16/73) *Construction must comply with al other applicable State and local regulations
LOT ARE T v). %sYv a �/l.cc-.GL
r
DAVIE COUNTY HEALTH DEPARTMENT �`)
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME �li,�n/r ; _ 1, %;i, !'i,.,ij✓ DATE ISSUED 7
ADDRESS i; C' PERMIT N0.
Explanation of charge, -
AMOUNT DUE
SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
10-5�4 b rLl - fuer-