1275 Rainbow Rd (3) IL
DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption JJ'ewa a Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CON CTOR t�] DATE /6' 3 ,CSS" PERMIT
LOCATION -t'� ,. SQ �[�-a //rot3 N� 1993
:, . S.R. NO.
SUBDI ISION NAME LOT N0. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME . BUSINESS ❑
NO. BEDROOMS ' NO. BATHROOMS House Trailer 800 Gal. 400 Sq. Ft.
- 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 ❑ NO ❑ ` Off .
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft. ,x/s,
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Publi ❑ /�a1Or C.t%/ l
IMPROVEMENTS PERMIT BY INSTALLED BYff
CERTIFICATE OF COMPLETION By /` Date
*Construction must"com 1 with al other a licable State and loca 're latio
(8/16/73) p y pp 1 g ns
LOT AREA
•I t'
14,11
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57 Q
HOCKSVILLE, N. C. 27028 �1
(704) 634-5985
Statement for Septic Tank Improvement Permits
i
and/or Site Evaluations
NAME ( r. `fr. i� './� yrL. DATE ISSUED `"��� 7e
C
ADDRESS PERMIT NO. ! /
//Vl
Explanation of charge / - �� ✓. !!r�`��yy`-- --� f U`% �=-C
AMOUNT DUE iii r� SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEN/NT.