P1525 Kennen Krest Rd 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 r ;; +. j' -' ^'1 ri 11 DATE ; f:: ..J :� PERMIT lr
LOCATION ? 1525
S.R. NO.
r SUBDIVISION NAMEt V LOT NO. SECTION OR BLOCK NO.
HOUSE Q MOBILE HOME 0 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 0' Three Bedroom House 900 Gal. 900 Sq. Ft.
AITTO. DISHWASHER YES ❑ NO ❑ Four. Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO, WASH. MACHINE YES [Z NO ❑
SITE SUITABLE YES [3' NO ❑
SIZE OF TANK �� ,f.' gal.
NITRIFICATION FIELD % '' ' sq. ft. j
DEPTH OF STONE IN LINES:
WATER SUPPLY: AIndividual ❑ Public ❑
IMPROVEMENTS PERMIT BY INSTALLED BY L .R129e44 Z.'
CERTIFICATE OF COMPLETION
By Date
(8/16/73) *Construction must comply with all other applicable State and local regulatis
LOT AREA
0A-10 X_3
3 s
r `
r
e"
. 114
DAVIE COUNTY HEALTH DEPARTMENT
P . 0. BOX 57
MOCKSVILLE, N. C. 27028
(7 04) 634-5985
Statement for Septic Tank Improvement Permits
and/'or_ Site •Evaluations
NAPE �' � �"�'`""`��»`�""^'' DATE ISSUED
ADDRESS ' L` �) PERMIT NQ.
Explanation of charge /
AMOUNT DUE SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT- OF THIS STATEMENT.