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1011 Peoples Creek Rd DAVIE COUNTY HEALTH DEPARTMENT A0 (Septic Tank) Improvements Permit and Certificate of Completion (Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C) OWNER OR CONTRACTOR l'�'3�iF?!�,a -i'a f , �E'1 DATE ` ! '� PERMIT LOCATION POD��/tP.� f: ��� :.,{ f _ �.n.j : ..:tom. �` N° 1534 +`c..u�� S.R. NO. SUBDIVISION NAME U LOT NO. SECTION OR BLOCK NO. HOUSE' Ct" MOBILE HOME E3 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 [" Three Bedroom House 900 Gal. 900 Sq. Ft. AUTO. DISHWASHER YES ©' NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft. AUTO. WASH. MACHINE YES 0' NO ❑ SITE SUITABLE YES ❑' NO ❑ f< C 2i. i',v " 'c•fes; %//V/�/�/ 1% SIZE OF TANK gal. NITRIFICATION FIELD `to o sq. ft. DEPTH OF STONE IN LINES: WATER SUPPLY: Individual ❑ Public ❑ IMPROVEMENTS PERMIT BY j�(1.,,. t'r -/� INSTALLED BY CERTIFICATE OF COMPLETION ' By Date -F (8/16/73) *Construction must comply wid all her applicable State and local egulations LOT AREA ��3//7 l t DAVIE COUNTY HEALTH DEPARTMENT �IA � P . 0. BOX 57 MOCKSVILLE, N. C . 27028 \. (704) 634-5985 Statement for Septic Tank Improvement Permits P P and/or Site Evaluations NAMEDATE ISSUED �11�7-)5� ADDRESS � PERMIT N0. � wo6• t53 Explanation of charge ' AMOUNT DF� SANITARIAN T. 1` PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS ST T.