P1825 Ruby WilliamsDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
`(mound Absorption Sewage Disposal System - G.S. Chapter.,130-Article 13C)
OWNER OR CONTRACTOR DATE 1 .' �` y:: PERMIT
T c
LOCATION f. f `s, 'j l� 1 0 2 5
S.R. NO.
.SUBDIVISION NAME y LOT NO. SECTION OR BLOCK NO.
NO. BEDROOMS
GARBAGE DISPOSAL UNIT
AUTO. DISHWASHER
AUTO. WASH. MACHINE
SITE SUITABLE
SIZE OF TANK
NO. BATHROOMS J
YES
❑
NO
YES
❑
NO
L]
YES
❑
NO
❑
YES
0
NO
❑
gal.
SS
NITRIFICATION FIELD _ _ sq. ft.
DEPTH OF STONE IN LINES:
t 71 LL
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.
J
INSTALLED BY
Af
CERTIFICATE OF COMPLETION
By 0 7 Date
(8/16/73) *Construction must comply with all other applicable Stat ocal re ations
LOT AREA
NT40
DAVIE COUNTY HEALTH DEPARTMENT ,<-� %
P. 0. BOX 57 J e'
A�OCK�VILLE, N. C. 2702
Q �/
(7 04) 634-5985 JPV/P-
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME � C�' "v��t.� DATE ISSUED
ADDRESS ��. ,�3a�G PERMIT NO.
Explanation of charge/j}.,�rt.'rY [� ('�✓r." L�
AMOUNT DUE Ij,y C) SANITARIAN
PLEASE REPdIT THE ABOVE AHOUNT ON RECEIPT OF THIS STATE'HENT.