P1953 Burton Rd DAVIE COUNTY HEALTH DEPARTMENT
J
P . 0. BOX 57
MOCKSVILLE, N. C . 27028 `
(704) '-634-.5985
C6
Statement for S.eptic. Tank Improvement Permits
and/or Site Evaluations
NAME � � DATE ISSUED
ADDRESS �� PERMIT NO.
aA
Explanation of charge.
y
AMOUNT DUE SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEM NT.
DAVIE COUNTY HEALTH DEPARTMENT � ��� ? f.
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption SewageDisposalSystem - G.S. Chapter 1130-Article 13C)
OWNER OR CONTRACTOR DATE rS' t 7P PERMIT
-- -
LOCATION S /4 V2
..a ° .mac. ,C,/� ��T , .., t1°�; L` t"; lr 1953
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑r 1MOBILE HOME E3 BUSINESS ❑
N0. BEDROOMS l NO. BATHROOMS f House Trailer 800 Gal. 400 Sq. Ft.
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 sq. ft.
DEPTH OF STONE IN LINES: /lJC1 •✓� /k'
WATER SUPPLY: Individual- ❑ Public r ❑
IMPROVEMENTS PERMIT BYL:�-- ,%i INSTALLED BY
CERTIFICATE OF COMPLETION By Date /-
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA ��