P1431 Farmington Rd r
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 �L) dN� DATE .' 1 f! PERMIT
LocATio it � ,: ;, ; .t i .�.t�r ,lk� N° 1431
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS ❑
' House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS rt 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 ❑ �1, -. �s, �,.�` kc'°- `'""'' A=. 4iaut •
SITE SUITABLE YES ❑ NO ❑
SIZE OF .TANK k"` gal.
AILS--
NITRIFICATION FIELD sq. ft. '�`{ " ��"
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DEPTH OF STONE IN LINES: 1`i" rrl 4,j
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY ,` ; c INSTALLED BY C"" �' S•%��
CERTIFICATE OF COMPLETION By rl 8' Date .a77
(8/16/73) *Construction must comply with all other applicable State.`and local regulations
LOT AREA
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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
NAP:E�� g (��ck DATE ISSUED
ADDRESS (ooZoZJ� t'arK F'iGIC� �Te+ PERMIT NO . ,
Explanation of charge
AMOUNT DUE,*j4d) SANITARIAN
PLEASE REMIT THE. ABOVE AMOUNT ON RECEIPT F THIS STATEMENT.
M-07