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4040 Hwy 801S DAVIE COUNTY HEALTH DEPARTMENT (Septic Tank) Improvements Permit and Certificate of Completion ('.round Absorption Sewage Disposal System - G.S. Chapter 130- rticle 13C)`,� OWNER.. �d IONTRACTOR ,rl �f/, r ;r r;��i� DATE PERMIT LOCATION f;'t `/ ._� ".` .` %- 'l' �.�/ ,/ !r . ir�" t%ei N? 1813 S.R. NO. SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO. HOUSE MOBILE HOME BUSINESS ❑ House Trailer 800 Gal. 400 Sq. Ft. N0. BEDROOMS .S N0. BATHROOMS _ Two Bedroom House 800 Gal. 600 Sq. Ft. " GARBAGE DISPOSAL UNIT YES ❑ NO Q'''om Three Bedroom House 900 Gal. 900 Sq. Ft. AUTO. DISHWASHER YES ❑ NO [3-' Four Bedroom House 1000 Gal. 1200 Sq. Ft. AUTO. WASH. MACHINE YES �❑ ',�� SITE SUITABLE YES CI'" NO [I ( /« ' SIZE OF TANK gal. NITRIFICATION FIELD sq. ft. 262 DEPTH OF STONE IN LINES: tv WATER SUPPLY: Individual ❑ Public ( r -. - - .'_ Co V ,.:) 11a).11 � ✓ IMPROVEMENTS PERMIT BY �'',, '= INSTALLED BY CERTIFICATE OF COMPLETION By Date (8/16/73) *Construction must comply with al other applicable State and local regulations LOT AREA J got DAVIE COUNTY HEALTH DEPARTMENT P. 0. BOX 57 HOCKSVILLE, N. C. 27028 (704) 634-5985 Statement for Septic Tank Improv ent Pere and/or Site Evaluations d NAME /�4.5©�?/ D' I S D D ADDRESS PE 4I / Explanation of charge �.*� ©p AMOUNT DUE SANITARIAN � PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.