524 Cana Rd DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank)"Improvements Permit and Certificate of Completion
U`cron�Absorpt n SewageDisposal'System - G.S. Chapter 1 0-Ar icle 13C)
OWNER OR CONTRACTOR f It .V�'/iAe DATE .���5�•�5•PERMIT
"G!/iJ��u�r�,v �� V
LOCATION /x /11 1 '�+'� , ."` !' /7 tN� 1797
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE . MOBILE HOME Ej BUSINESS ❑
{� ✓ House Trailer 800 Gala 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 NO ❑
SIZE OF TANK C/ gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: IndividualPub. ic
IMPROVEMENTS PERMIT BY ' INSTALLED BY
...
CERTIFICATE OF COMPLETION
BY Date
(8/16/73) ' *Construction must comply with a of er a' 3c�t .6tafe and local regulations
LOT AREA
J�
1 • �Y/ _
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME A A DATE ISSUED
ADDRESS PERMIT N0. 202
Explanation of charge ,!:��*- vo
AMOUNT DUE _ SANITARIAN_������G
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.