185 Droke Circle Lot 22 • DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
"NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name- -- ./, l, Date �'�!�✓ i�1 t?. $ .f
Location
Subdivision Name -.- 7� Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES � NO ❑ 'i '�
Auto Wash Machine YES [D NO ❑
Type Water Supply
*This permit Void if sewage system described below is not installed-within 36 months from date of issue.
Improvements permit by
*Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
+ / i
i
Final Installation Diagram: System Installed by
Certificate of Completion ` -%' Date
*The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion -
, ,; (Ground Absorption Sewage Disposal System G.S. Chapter 1 O-Artc1 13C)
OWNER"0k'CONTRACTOR t j'�f j 5;o I, �1 DATE > RMIT
LOCATION __ l:'� �✓� / r r' ^"i N? 1682
S.R. N0,
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE Q' MOBILE HOME BUSINESS ❑
N0. BEDROOMS NO. BATHROOMS - .'House Trailer 800 Gal. 400 Sq. Ft.
. :Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT .-YES [3 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 �3 YES NO ❑
SIZE OF TANK [/ gal.
NITRIFICATION FIELD sq. ft. �
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public
IMPROVEMENTS PERMIT BYE ' INSTALLED BY �U
CERTIFICATE OF COMPLETION
BY Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
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ova 4 ..�.'
/470'
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DAV I E COUNTY HEALTH DEPART14ENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME . �� 7 DATE ISSUED
ADDRESS PERMIT N0.
Explanation of charge
AMOUNT DUE SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.