P1977 Peoples Creek Rd DAVIE COUNTY HEALTH DEPARTMENT I�tp
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter/130-Article 13C)
OWNER OR CONTRACTOR t` G2r#� .: �;:� rC.�:> �t .+: �Z ,� DATE � / ,''� % PERMIT
LOCATION ,., _ i w .ti.1 :� ✓ , N9 19.7
S.R. NO.
SUBDIVISION, NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME E3 BUSINESS ❑
/
House Trailer 800 Gala 400 Sq. Ft.NO. BEDROOMS .J 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 NO ❑ /:/j ry%{ -L�*�•f� j;�
SITE SUITABLE YES ❑ NO ❑
SIZE OF.TANK gal.
NITRIFICATION FIELD sq. ft. /
DEPTH OF STONE IN LINES:
7�
WATER SUPPLY . Individual_ ' ❑ Public ❑ L-0;
f
IMPROVEMENTS PERMIT BY. ��C�- t- 1 ('t-k;E�/ INSTALLED B J
CERTIFICATE OF COMPLETION ..,Byl q-kl Date
(8/16/73) *Construction must comply. with al other applicable State and local rPgulations
LOT AREA
-70
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DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
MOCKSVILLE, N. C. 27028
/ (70 x„_634-5955
Starteacut for Septic, lmptavem�nt Permits TY
and/ Site Evaluatians
NAME GV /��t - DATE ISSUED - 7�
ADDRESS 'PERMIT NO. Z97Z
D w 0,65,
itExplanation of charge ;
r
J
AMOUNT DUE 1 . , SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON 'RECEIPT OF THIS STATEMENT.