1275 Rainbow Rd (2) 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 DATE C) cS' PERMIT
LOCATION .
. - 5 t t N° 1992
.. t � � 2 r-*
R. NO.
SUBDIVISION NAME'' LOT NO. SECTION OR BLOCK NO.
HOUSE ] MOBILE HOME 0 BUSINESS ❑
?iHouse Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS 3 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 ❑
SITE SUITABLE YES [3 NO Q �Jp4)�-j. �.
SIZE OF TANK gal. Qr
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: r
WATER SUPPLY: Individual .❑ P blYiic y ❑
IMPROVEMENTS PERMIT BY INSTALLED BYv
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must comply witvh all other applicable State and local regulations
LOT AREA
13
t
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985 l
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME �. ��� DATE ISSUED P
ADDRESS PERMIT NO. �L —
Explanation of charge
AMOUNT DUE SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATENiEN .