P1684 Singleton Rd DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Grbund-Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTORS {,tt,: c 1Cn DATE / 7e PERMIT
LOCATION t.,iot S-' 1=\ %CZ1 dlr,=3 Veit 1684
4- ,Uc ►a;, F ;:ice %t rl ' ' S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
N0. BEDROOMS 6. NO. BATHROOMS V4 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 0- NO ❑ Four Bedroom House 1000 Ga 1200 Sq. Ft.
AUTO. WASH. MACHINE YES Q NO ❑
SITSIZE OFITANKE O� YES 0 NO [3
DfNITRIFICATION FIELD sq. ft. �i
DEPTH OF STONE IN LINES. �ge
WATER SUPPLY: IndividualPublic ❑
IMPROVEMENTS PERMIT BY . JX)' .•,JO INSTALLED BY C�
r
CERTIFICATE OF COMPLETION BY Dat
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
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DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57 �Gl�
MOCKSVILLE, N. C. 27028 �• !�
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or. Site Evaluations
NAME �;C�,� � �o��j'Q,, DATE ISSUED
ADDRESS -} �� ,ri 19 3 PERMIT NO.
Explanation of charge
AMOUNT DUE 4 jS Ub SANITARIAN_
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT."