P1589 Deadmon Rd DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
'-'(Ground Absorption SLe, , Disposal System - G.S. Chapte 0-Ar icle 13C)
OWNER OR CONTRACTOR Ci fJj/j _ _DATE ERMIT
pp N° 1589
LOCATION
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSEMOB ❑
ILE HOME BUSINESS
t House Trailer 800 Gal. 400 Sq. Ft.
N0. BEDROOMS NO. BATHROOMS
Two Bedroom House- 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT; YES ❑ NO 13 Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES .❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE ` YES ET, NO ❑
SITE SUITABLE : i .YES [3 NO ❑ r �„„ e �~" �
,.
SIZE OF TANK gal.
NITRIFICATION FIELD~ sq. ft. '
DEPTH OF STONE IN LINES: '
WATER SUPPLY: Individual ❑ Pub . c
V)At�f•t
IMPROVEMENTS PERMIT BYE._ `/ INSTALLED BY
CERTIFICATE OF COMPLETION By Date 7'T
r =-=--7-
(8/16/73) *Construction must ,c rly wit all other a�rlicable State and local reEulations
LOT AREA
r
_ DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System G.S. Chapter 1; O-A ticle 13C)
OWNER OR CONTRACTOR -. �, is DATE 1_ PERMIT
��. ,_
LOCATION , .,,.. . . fJ V f r 1589
' S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE [].+-^^MOBILE HOME Ej BUSINESS ❑
NO. BEDROOMS '/,, House Trailer 800 Gal. 400 Sq. Ft.
N0. 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 ❑XNO ❑ Four Bedroom House 1000 Gal. , 1200 Sq. Ft.
AUTO. WASH. MACHINE YES [ NO ❑ �
SITE SUITABLE YES C3 NO [3
SIZE OF TANK gal.
NITRIFICATION FIELD'' sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Pub4c .
IMPROVEMENTSPERMIT BY INSTALLED BYi,2"
,r
CERTIFICATE OF COMPLETION BY Date J1)— 77 "
-y�v-� �---T
(8/16/73) *Construction must :c rly wit all other applicable State and local reEulations
LOT AREA
3-�7fjw.
L
DAVIE COUNTY HEALTH DEPARTMENT
P. O. BOX 57
I HOCKSVILLE, N. C. 27028
{ (704) 634-5985
_- Statement for'; Septic Tank Improvement Permits
and/or* Site Evaluations
NAME.' *; DATE I
ADDRESS ..;.;/ PERMIT -NO r
Explanation of charge "i I ��:'r %i�L�� 1'
AMOUNT DUE SANITARIAN �{��
PLEASE REMIT THE `�BOVE AMOUNT ON RECEIPT OF THIS STATEMENT.