2039 Hwy 601S DAVIE COUNTY-HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 13-0,oAr. icle 13C)
OWNER OR CONTRACTOR 'L'pN ISE /n)41/FIFL P DATE lJ PERMIT
LOCATION tvFJt TC- i,g12jLD k' 0 R?c),t'rf5, L:-'I-.LIS L1.,e-- N TG je (fir" 1627.
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ ,-MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS Cl NO. BATHROOMS
Two Bedroom House 800 Gal. ' -600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO 0' Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO [Zr Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES Q NO ❑
SITE SUITABLE YES [3' NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft. 1 3 x
DEPTH OF STONE IN LINES
W6 LL_ w
WATER SUPPLY: Individual ❑ Public ❑ _
1°�S' INSTALLED BY
IMPROVEMENTS PERMIT BY ��-�-� �/.�n.►tic l� �'
CERTIFICATE OF COMPLETION By- 061,1 Date
i
(8/16/73). *Construction must comply with all dther appl cable State and local.regulations
LOT AREA.
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DAVIE COUNTY HEALTH DEPARTMENT
s
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(7 04) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations !/
101-7
NAME Q-ttt.�2.�, DATE ISSUED /7
ADQRESS is I PERMIT N0.
Explanation of charged
AMOUNT DUE �J, J— SANITARIAN 7
PLEASE REMIT THE ABOVE AP40UNT ON RECEIPT OF THIS STATEMENT.