298 Aubrey Merrill Rd DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
.(Ground Absorption Sewage Disposal System - G.S. Chapter 130- rti_9le 13C)
OWNER OR CONTRACTOR , i/= f /r��;/°J/ t s,; r;*.�' DATE � �'; PERMIT
LOCATION 1 : .��: �:�`- 4.,,A-4-, ,, ;:r- : ' ;;:. , r• - N° 1914
-S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME tJ INESS ❑
f_/ House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS N0. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO Er'
[a-" Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES PNO
❑ E NO Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES 0SITE SUITABLE r YES ❑ r r ''
SIZE OF TANK � gal.
NITRIFICATION FIELD sq. ft. �',
DEPTH OF STONE IN LINES: �7 r
WATER SUPPLY: Individual ❑ Public 2V
IMPROVEMENTS PERMIT BY �� ''"` INSTALLED BY !J (,G�4�
CERTIFICATE OF COMPLETION By , Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
/0 /1 /
Af
r
..-...�."f ...... M-.-..
I , I
J _
• }
C �
DAVIE COUNTY HEALTH DEPARTME t
P . 0. BOX 57
` MOCKSVILLE , N. C . 2702
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAP,:E f&,- II-I)eegljljljJ"A- DATE ISSUED
ADDRESS PERMIT N0 . ,J-S/
Explanation of charge � iy
AMOUNT DUE /6—CV SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
DAVIE COUNITY HEALTH DEPS.
DALE
Nat
---- COMMIE NTS f
HnLE_P10,
2
U� �D d 7- T
0 '
0 QY
Lot ) anram
01 � .