P1651 Howardtown Rd 4prDAVIE COUNTY HEALTH DEPARTMENT 7 l20 �
(Septic Tank) Improvements Permit and Ceriificate of Completion
(Ground Absorption Sewage Dispersal S stem -, G.S. Chapter 13 -Ar icle 13C)
OWNER -OR CONTRACTOR �, Q.,rj /?!+r,.cr DATE PERMIT
LOCATION i '." 1\O 1651
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS _ NO. BATHROOMS _ 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 Q,,d.--NO in
SIZE OF TANK t _ gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: ,ter .,'-_" _;�� �,•�°
WATER SUPPLY: Individual g1 Publi ❑ �L � �J/�
IMPROVEMENTS PERMIT BY G INSTALLED BY �zIC"ld
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
/✓o bay use
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DAVIE COUNTY HEALTH DEPARTMENT
P . 0. BOX 57C
MOCKSVILLE, N. 1C . 27028
(704) 634
: Statement for Septic Tank Improvement Permit's
and/or Site Evaluations
\ 7
NAME DATE
� ^W re
DATE ISSUED/
ADDRESS j ,,� ,� PERMIT NO.
Explanation•' of charge_
AMOUNT. DUE ),�''' SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF .;THIS STATEMENT.