P1925 Alan HallDAVIE 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 PERMIT
LOCATION N? 1925
S.R. NO.
SUBDIVISION NAME LOT NO; SECTION OR BLOCK NO.
HOUSE MOBILE HOME Ll BUSINESS ❑
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES 0 NO ❑
AUTO. DISHWASHER YES C3 NO rl
AUTO. WASH. MACHINE YES 0 NO 0
SITE SUITABLE YES [3 NO [3
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual 0 Public
IMPROVEMENTS PERMIT BY
j
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
CERTIFICATE OF COMPLETION y Da
(8/16/73) *Construction must comply wit h all 0/1 er applicable State and local regulations
LOT AREA,
AL
h
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57�i�
MOCKSVILLE, N. C. 27028 U Ak
(7 04) 634-5985
Statement for. Septic Tank Improvement Prmits 9
and/or.Site Evaluations
NAME DATE ISSUED—
PERM
SSUED
ADDRESS �!,.; PERt�1IT N0.
Explanation of charge
AMOUNT DUE / SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEHEHT.