P1501 John D Elrodr-
DAVIE 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 Wiv., Q DATE y/ ' /7/ PERMIT
LOCATION fc-
S U
S.R.- NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
`7--- r
House Trailer 800 Gal. 400
Sq. Ft.
NO. BEDROOMS N0. BATHROOMS i
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 6,90 sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BYlr'f'' . • 1 ..(-r f...
INSTALLED BY
CERTIFICATE OF COMPLETION a O—Iz, <a—W1JZVZ s :?15/77
By Date
(8/16/73) *Construction must comply with aly other applicable State and local re ulations
LOT AREA
r-
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
MOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME 4 ^v=:- � /.{J)�'�` DATE ISSUED f
ADDRESS !%�;��% t „j � PERMIT NO.
Explanation of charge
AMOUNT DUE j t`� SANITARIAN�,�
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STA EMENT.