917 Howardtown Rd ~ DAVIE COUNTY HEALTH DEPARTMENT
-. (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR e` ;r' >) f: tl-,tip DATE ;rjll t 17 PERMIT
LOCATION3. ,i<^s 1 n.r ll. 1 �7 t !�';i i �i t!1 r-r+.e tt ��/I.•1; �1�r i� • 1958
J S.R. NO.
SUBDIVISION'NAME LOT N0. SECTION OR BLOCK NO.
HOUSE [E' MOBILE HOME t3 BUSINESS ❑ -
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS �'-' N0. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
`GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. 'DISHWASHER YES ❑,..• 130n/LQ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ C� -=-
SITE SUITABLE ES
SIZE OF TANK
r !
NITRIFICATION FIELD' �, sq. ft.
DEPTH OF STONE IN NES:
WATER SUPPLY: Individual Public ❑ �=y' r` � L%' ;
.IMPROVEMENTS PERMIT BY Fes-. lc,L{!t„ =t, INSTALLED BYjs����d rcr.
CERTIFICATE OF. COMPLETION By Date ro "3a '? 5--
(8/16/73.) : *Construction must com y with all other applicable State and local regulations
LOT AREA
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DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57 �
MOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations ¢ �/
%ZI.C.�
NAME ��� DATE ISSUED
ADDRESS /� �� / Y PERMIT NO.
Explanation of charge
AMOUNT DUE / """" SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF- THIS STATEMENT.'. .
DAVDEPARTMENT ,
IE COUNTY HEALTH
P . 0. BOX 57
MOCKSVILLE , N. C . 27028
(7 04) 634-5985 5ECOf� PJnTICE
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME Mr, Loroy Nivons DATE ISSUED a/113 713_
ADDRESS Route 6, Box 129D PERMIT NO. 1958
Plockovilla, N&C. 27020
Explanation of charge-1 improvomonbs permit for house on the
Howardtaun Road
AMOUNT DUE 515,00 SANITARIAN 1* Plando
PLEASE REMIT THE ABOVE A140UNT ON RECEIPT OF THIS STATEMENT.