2027 Milling Rd (2) DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground-Absor"poon Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR J 41 C I CtT r rC DATE 'r (�"777 PERMIT
LOCATION �[ ;.,� t ..- +--- ri" �'l l� 1614
- a S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.,
HOUSE Q - MOBILE HOME 0 BUSINESS ❑
r House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS ,� NO. BATHROOMS G'' 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 Cis NO ❑ --^ """
SITE SUITABLE YES Dr N0 ❑ (�) r r'' �`'-,�.� '�"�'' "
SIZE OF TANK #/ 0/) gala
NITRIFICATION FIELD sq. ft.
r( 3
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual B Public ❑ t�,, ��
IMPROVEMENTS PERMIT BY !Jrf'n, i�;4� � INSTALLED BY
CERTIFICATE OF COMPLETION
BY Date
(8/16/73) *Construction must comply with all dther applicable State and local regulations
LOT AREA
/•AFL /Od
100 7
W---- ............
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DAVIE COUNTY HEALTH DEPARTMENT
P. 0.• BOX 57
MOCKSVILLE, N. C . 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Sitte- Evaluations
NAME % �''�- DATE ISSUED
ADDRESS 1 PERMIT NO.
�10
Explanation of charge 1
AMOUNT DUE / ' SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.