P1893 Tommy AnthonyDAVIE 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 DATE �; r.f..'' PERMIT
LOCATION
N? 1893
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME ❑ BUSINESS ❑
NO. BEDROOMS r 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
r
CERTIFICATE OF COMPLETION J�`,- f��
eY
(8/16/73) *Construction must comply with all
LOT AREA f `
N
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
-' �i o -r N11NpO Date VA76
ther applicable State and local regulations
Ali
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57 l'ti
MOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or S"'te Evaluations`
NAME DATE ISSUED
ADDRESS U .�Ju^ ' PERMIT NO. J,
Explanation of charge ,
AMOUNT DUE `'-`"
SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.