674 Junction 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 ;� :, `• "• :',, `,'rr „'` ''r`'' DATE PERMIT p
LOCATION <:��=✓.f` �' :: �,e 1� 0 9
1 ' S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME E3 BUSINESS ❑
NO. BEDROOMS � NO. BATHROOMS �_ House Trailer, 800 Gal. 400 Sq. Ft.
Two Bedroom House' 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO []t Four Bedroom House', 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES Lam'. NO ❑
SITE SUITABLE YES C"3'"r NO ❑ 01
SI ZE OF TANK x� gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: /Zt,R
t ,.
WATER SUPPLY: Individual ❑ Public
IMPROVEMENTS PERMIT BY INSTALLED BY / .,�
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CERTIFICATE OF COMPLETION
B Date
(8/16/73) *Construction must comply wit all ther applicable State and locaT re ulations
LOT AREA ..�,�..
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DAVIE COUNTY HEALTH DEPARTMENT
P. 0. B O X S
F40CKSVILLE, N. C.
27028
(704) 634-5985 ///
Statement for Septic Tank Improvement Permits
and/or Site Evaluations . ..�'
NAME DATE 'ISSUED,5---,4?—�
ADDRESS PERMIT NO. f
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Explanation of charge
AMOUNT DUE �'f.. SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.