P1638 Steve ReavisDAVIE 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 i " r\ G DATE IC / . , / ;1 7 PERMIT
LOCATION 1638
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE p MOBILE HOME ❑ BUSINESS
NO. BEDROOMS
r -y= NO. BATHROOMS
GARBAGE DISP_O_SAL UNIT YES Q NO ❑
AUTO. DISHWASHER YES Q. NO ❑
AUTO. WASH..MACHINE ,YES Cf NO ❑
SITE SUITABLE YES CJ NO ❑
SIZE OF TANK (i gal.
NITRIFICATION FIELD -:r i; sq.
DEPTH OF STONE IN LINES: !`
Public ❑
WATER SUPPLY: Individual ❑
IMPROVEMENTS PERMIT BY /,A r`
ft.
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 /It fr,
CERTIFICATE OF COMPLETION B �,�� Y� ` Date
(8/16/73) *Construction mu "c ly`wit hit
ll other applicable State and loco g{s
LOT AREA
10,�!l .drilZt.G�Gf' L ✓oto'
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
NMOCKSVILLE, N. C. 27028
(7 04) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAP,:E vue-, DATE ISSUED
ADDRESS PERMIT NO.
Explanation of charge
AMOUNT DUE/� � SANITARIAN 1)�. P\ -,c
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.