1089 Country Ln (2) I
DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Se wag Disposa System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR /t1 z>.:r;�-�° t. r,./JiDATE PERMIT
LOCATIONf'+�' ufc. t•i�' z .i :�t�tz?'` `Zt(�"3E. ! "' �..tr'�il� sT- t . n� N'D 1946
r
,,g f f( Jo ,n u I �� s'7..rA-� 1� lY:/.J� �yar. �, S.R. N0,
SUBDIVISION NAMEir LOT NO. SECTION OR BLOCK NO.
HOUSE Q' MOBILE HOME BUSINESS• 0
House Trailer .800 Gal. 400 Sq. Ft.
NO. BEDROOMS NO. BATHROOMS , Two Bedroom House 800 Gal. 600 Sq. Ft.
Three Bedroom House 900 Gala 900 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ED"'
AUTO. DISHWASHER YESQ NO [3Four Bedroom House 1000 Gala 1200 Sq. Ft.
AUTO. WASH. MACHINE YES [P NO ❑ /^ r f� e--
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: `,
WATER SUPPLY: Individual ❑ ic
IMPROVEMENTS PERMIT BY ��%: V V, 164
{1 ., INSTALLED BY ,
CERTIFICATE OF COMPLETION By / Date ����
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA � r' 'r"I`
i ..
44,Oat
fi I ,
i
t't
i
X
Jil
i
i
DAVIE COUNTY HEALTH DEPARTMENT
P . 0. BOX 57 '
MOCKSVILLE, N. C . 27028
(704) 534-5985 SECOND NOTICE
--Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME n,,,r�r„ nine- t �3�� r.,,,.�Y„ - ----DATE--,ISSUED
ADDRESS�,,,,� „ nc:, PERMIT N0.
7 --
7
Explanation of charge 1 ^itn mrnitI-+finn noir
for house located on Country Ln.nn
AMOUNT DUE 120,00 SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.