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133 Hickory Drive Lot 2 Section 3Davie Countv. NC Tax Parcel Report h 62 �( -IA Monday. October 10, 2016 VVAK1V11V1i: 1111J 1� 1VU1 A JUKVh1 Parcel Information Parcel Number: J515OA0005 Township: Mocksville NCPIN Number: 5747173309 Municipality: Account Number: 82524917 Census Tract: 37059-805 Listed Owner 1: LAROQUE ESTHER Voting Precinct: SOUTH MOCKSVILLE Mailing Address 1: 133 HICKORY DRIVE Planning Jurisdiction: MOCKSVILLE Cit— MOCKSVILLE Zoning Class: MOCKSVILLE GR All data is provided as is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the Davie County, Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to NC or arising out of the use or Inability to use the GIS data provided by this website. State: NC Zoning Overlay: Zip Code: 27028-4211 Voluntary Ag. District: No Legal Description: LOT 2+ SOUTHWOOD ACRES SECTION 3 Fire Response District: MOCKSVILLE Assessed Acreage: 1.21 Elementary School Zone: MOCKSVILLE Deed Date: 3/2012 Middle School Zone: SOUTH DAVIE Deed Book / Page: 008850394 Soil Types: GnC2 Plat Book: 0004 Flood Zone: Plat Page: 141 Watershed Overlay: MOCKSVILLE Building Value: 159920.00 Outbuilding & Extra Freatures Value: 620.00 Land Value: 20500.00 Total Market Value: 181040.00 Total Assessed Value: 181040.00 All data is provided as is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the Davie County, Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to NC or arising out of the use or Inability to use the GIS data provided by this website. Perjm4�ee's (;; DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTYINFORMATION 7gqr"��z ,, P.O. Box 848 Directions to property: r " -�' Mocksville, NC 27028 Subdivision Name: " ` 11 t a1 c u(c lei Phone #: 336-751-8760 Section: ='`- Lot: �`• AUTHORIZATION FOR 7 CWASTEWATER Tax Office PIN:# J SYSTEM CONSTRUCTION O cd; — AUTHORIZATION NO: Q 0 210 39 A Road Name: 0t, -( Zip: **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) t.-;;;,•- `f;: `�"` •. -1,P-6 � *NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No t-` f LOT SIZE �' Ct TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) •.� (e " NEW SITE REPAIR SITE c SYSTEM SPECIFICATIONS: TANK SIZE L• \� t GAL. UMP TANK,4VAGAL. TRENCH WIDTH 5I ROCK DEPTHLV//jLINEAR FT.,QO AS stated in J:j,-k 7,10pC .1� E3�.1c,.7J(t��J �accr rt d %%terns rnar alsa b s :,oa lITIICD REQUIRED SITE MODIFICATIONS/CONDITIONS: t 0-51C.) t', -C V- CIL`, L "! 0 V- c` `1 (.t wt b --P 1/ 4) IMPROVEMENT PERMIT LA I I OM.A [71 J l 10 tN c � too U. t� gyp\ zl- I ! I !;'irr )I- L I FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:3a/ *K -.M. ON )MRATION PERM �as D '47 — SYST-EM IP+STA6LED $Y: 6V-ya,, ft\- t Da TELEPHONE # IS (336) 751-8760. `--"a 'r C`. 4 r+c• l,..l fi r4--1 trl' _. 7 E �3a -mss AUTHORIZATION NO. ZO 1 OPERATION PERMIT BY: k DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT T SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I 1 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 02N2 (Revised) Cs C1, -Ti V Iv G **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie Countv Environmental Health Section prior 'to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ` .•' i*NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ° ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE 5 r- # BEDROOMS 3 # BATHS -# OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No f "c LOT SIZE �� (� C#TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) ��' NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE - t GAL. PUMP TANK / I AL. TRENCH WIDTH fit ROCK DEPTH A LINEAR FT.l "`7 OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: C 0—o C A., -r"- CX �, k- - t <.),( C. k r 4 t V1 U -P 1,j S I IMPROVEMENT PERMIT LA 10, rrs�r R o v ' d t oto. FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30000 X . ON THE DAY OppL' INSTALLATION. TELEPHONE # IS (336) 751-8760. !I t 1 ^1 — r'1 r -, r, -c .,,, i t-r.r I 61 )?ERATION PERMI s . SYSTEM INSTALLED BY: t4 I y AUTHORIZATION NO. Zd 3 t OPERATION PERMIT BY: i DATE: 2 -1z_ -6J "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT TK SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I I OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. ncHo 02ro2 (Revised) .-T Pei C &z/n- -2' /Z-04- /v. -3J J " Permittee s� i-) DAVIE COUNTY HEALTH DEPARTME�/ . N ;, -~ w": -" _' �- r' �' 0e_1 Ld t -- Environmental Health Section kOPERTY INFORMATION CU2C�lt j 1: . = Directions to property: P.O. Box 848 Ivlocksville, NC 27028 Subdivision Name: t_Llnc:r - i*.: �, ik it.ek j L) Phone #: 336-751-8760 ` ; Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:#,} / G 1 1 `_ c SYSTEM CONSTRUCTION AUTHORIZATION NO: a 0 2 F 1 91 A Road1Name: f z `� ' } r , , ` Zip: **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie Countv Environmental Health Section prior 'to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ` .•' i*NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ° ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE 5 r- # BEDROOMS 3 # BATHS -# OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No f "c LOT SIZE �� (� C#TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) ��' NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE - t GAL. PUMP TANK / I AL. TRENCH WIDTH fit ROCK DEPTH A LINEAR FT.l "`7 OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: C 0—o C A., -r"- CX �, k- - t <.),( C. k r 4 t V1 U -P 1,j S I IMPROVEMENT PERMIT LA 10, rrs�r R o v ' d t oto. FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30000 X . ON THE DAY OppL' INSTALLATION. TELEPHONE # IS (336) 751-8760. !I t 1 ^1 — r'1 r -, r, -c .,,, i t-r.r I 61 )?ERATION PERMI s . SYSTEM INSTALLED BY: t4 I y AUTHORIZATION NO. Zd 3 t OPERATION PERMIT BY: i DATE: 2 -1z_ -6J "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT TK SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I I OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. ncHo 02ro2 (Revised) .-T Pei C &z/n- (kV 814� a bod r" /adikll 1; A / 6 - 3 DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION 04// lt�G►�� ap�0 , APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) 1 / NAME �� VC. PHONE NUMBER ��77- 4Z©6 ADDRESS lk (A(4 j� & SUBDIVISION NAME r< G&20D�r � - LOT # IS DIRECTIONS TO SITE dS / ar1y Ze-F �Otqsl 4sh 'ler0l /1—ylh &oacl DATE SYSTEM INSTALLED 1077 NAME SYSTEM INSTALLED UNDER TYPE FACILITYANUMBER BEDROOMS NUMBER PEOPLE SERVED TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING A&e-/ /'. i n DATE REQUESTED O INFORMATION TAKEN BY This is to certify that the information provided is correct to the best of my knowledge, and that I understand I am responsible for all charges incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev. 1/93 �" r v AUTHORIIOl, NO 1 2 9 DAVIE COUNTY HEALTH DEPARTMENT Te'Ia La Rqa_ Environmental Health Section PROPERTY INFORMATION P.O. Box 848 t Name:T Mdr'ocksville, N6' 28 Subdivision Name Directions to property: • °� !'� .�'• i^�' �!�° 3 J Xc Phone #: 704- -8760 AUTHORIZATION FOR WASTEWATER . SYSTEM CONSTRUCTION ry Section:- t "tee P, Lot: Tax Office PIN:# - - p } a RoadName: ',r- .. % ° f `x Z)p: e�t **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Fonn/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION 4:,;K-,rn Axl, IS VALID FOR A PERIOD OF FIVE YEARS. ;NVIRONMENTAL HEALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS #BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes of No COMMERCIAL SPECIFICATION: FACILITY TYPE '# PEOPLE # PEOPLE/SHIFr # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY f .h DESIGN WASTEWATER FLOW (GPD) —x"�G NEW SITE REPAIR SITE l•-/� SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEARF'I REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT 7' t Vwq F__7 DX�XJ2 4/1)./ejF1 f eOYI .-5-7,4 d , Nlf It "CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT FSTALLED AUTHORIZATION NO. 9 OPERATION PERMIT BY: DATfi:� rlJ' "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. ut.Hu uwno (Kevisea) AUTHORIZATION NO- 219 DAVIE COUNTY HEALTH DEPARTMENT t''° A L-a ReVAt._ Environmental Health Section PROPERTY INFORMATION Permittees :�; P.O. Box 848 Name. j, r.�.` m✓ sem, •�` �r�,l:.,�r�,f, ' � y Mocksville, N 28 Subdivision Name. `` _. Phone #: 704-760 Directions to property: 3 i_/1 1 �/ Section: 't r,* AUTHORIZATION FOR Lot: " WASTEWATER _ Tax Office PIN:# - - SYSTEM CONSTRUCTION � Roa Name:l Zip: **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED 2 t DAVIE COUNTY HEALTH DEPARTMENT e ,. a1 -a 2Q�p ROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION PeQiiii Nam1• e:�� ��f:�, r� rs,-,.�..,,f . Subdivision Name' Directions to property: /�• c t' �"q ' Section .' _�.- Lot: f f IMPROVEMENT _ J. r `✓ r'?1, - r- A- PERMIT Tax Office PIN:# ` Road N me r x7c`Zip. **NOTE** This Improvement Permit DOES NOT authorize the construction or installation of aseptic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM C014STRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit. t (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE 12�— # BEDROOMS I? # BATHS 47 # OCCUPANTS _ GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS " INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE L.-/' 1A 0 SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH , LINEAR FI REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT Ilea i 1 i r� ),mlecl- el�aa � "CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT �1 NSTALLED BY: /� r✓ bp� r AUTHORIZATION NO. ��`'` OPERATION PERMIT BY: DATE !� "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 05/96 (Revised) DAVIE COUNTY HEALTH DEPARTMENT r` 'be el j?,)1MrROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Perrciitteets a ` U Name:x A v �r'` "f Subdivision Name r "'. ; »''_ _ ✓1 Directions to property: ,% ,.e 1 Section: Lot- r IMPROVEMENT %� ;! ' •',`'I PERMIT Tax Office PIN:# - - Road &ame L�—e Zip **NOTE** This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit. t (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) r ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE /7�— # BEDROOMS -�? # BATHS wl # OCCUPANTS GARBAGE DISPOSAL: Yes or No,' COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY_ DESIGN WASTEWATER FLOW (GPD) NEW SITE +� -REPAIR SITE f -� r 0/ SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK /GAL. TRENCH WIDTH ROCKDEPTH FI OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT f v "CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT VSTEff%1 TAL "" e - r- AUTHORIZATION NO. OPERATION PERMIT BY. DATE "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I I OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM ,WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. ,DCHD 05/96 (Revised) i DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION WORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT NAME PHONE NUMBER fO,�;T ADDRESS r SUBDIVISION DIRECTIONS TO SITE NAME .ck&--t ) ZV %- SUBDIVISION LOT DATE SYSTEM INSTALLED_ NAME SYSTEM INSTALLED U SPECIFY PROBLEMS OCCURRING y DATE REQUESTED �! INFORMATION TAKEN BY DAVIE COUNTY HEALTH DEPARTMENT (Septic Tank) Improvements Permit and Certificate of Completion (Ground Absorption Sewage System - G.S. Chapter 130 -Article 13C) tDisposal OWNER OR CONTRACTOR:) c '< ,, : r :j DATE 7 PERMIT LOCATIONS c'' IS N9 1331 S.R. NO. SUBDIVISION NAME LOT NO. I f t 113 SECTION OR BLOCK NO. HOUSE MOBILE HOME BUSINESS ❑ " BATHROOMS House Trailer 800 Gal. 400 Sq. Ft. NO. BEDROOMS ..:J NO. Two Bedroom House 800 Gal. 600 Sq. Ft. GARBAGE DISPOSAL UNIT YES ❑ NO Three Bedroom House 900 Gal. 900 Sq. Ft. AUTO. DISHWASHER YES Q' NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft. AUTO. WASH. MACHINE YES Q' NO ❑ SITE SUITABLE YES E!I' NO ❑ SIZE OF TANK - 70V gal. NITRIFICATION FIELD sq. ft. DEPTH OF STONE IN LINES: WATER SUPPLY: Individual ❑ Public IMPROVEMENTS PERMIT BY INSTALLED BY CERTIFICATE OF COMPLETION By— (8/16/73) Y— (8/16/73) *Construction must LOT AREA Q i\r ,, >, %'i a,An Date 11-1-7-77 ly with all other applicable State and local regulations 3oz'10 "If /;I" f.I,-,e 4