P1945 Link Rd R
DAVIE COUNTY HEALTH DEPARTMENT
e ' (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130Article 13C)
OWNER OR CON-TRACTIOOR �r 'T.✓.,/ !e�+� 1_..+�' DATE - r >; PERMIT
LOCATION �;/. "�H�" f% r7 L� :..�''� . _!rf,, tv i�(it>�vq - N° 1945
SUBDIVISION NAME LOT NO.
� SEGTf& 0 BLOCK 0 r
HOUSE ❑ MOBILE HOME -'` BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS N0. BATHROOMS I Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO 0'fi Three Bedroom House 900 Gala 900 Sq. Ft.
AUTO. DISHWASHER YES �❑��.�' NO Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES C7,,-'NO ❑
SITE SUITABLE YES Er NO ❑ ( . , �•.�.•�
SIZE OF TANK gal. Y~
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individua ❑ Public
IMPROVEMENTS PERMIT BY ✓ .r E:t - INSTALLED BY `li' - -��-�- ; >t
CERTIFICATE. OF COMPLETIONBy t""'
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
4
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DAVIE COUNTY HEALTH DEPARTMENT
P . .0. BOX 57 U
MOCKSVILLE, N. C . 27023
(7 04) .634-5935
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NXt4E DATE ISSUED/a/C;L?/,
� r
r
ADDRESS -7PERMIT NO .
7d1
Explanation of charge C
O'V
AMOUNT DUE 6, SANITARIAN
PLEASE REMIT THE ABOVE A14OUNT ON RECEIPT OF THIS STATEM NT. �