209 Kent Ln 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 DATE t' i PERMIT
LOCATION �"e t.t. lr� �/ _,; � � ,,L., O 1685
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME t3 BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS NO. BATHROOMS i 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 ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑ , `
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
r
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ ,.Public ❑
IMPROVEMENTS PERMIT BY t lr: INSTALLED BY
CERTIFICATE OF COMPLETION By — 6�f 1 I U Date 3 a
(8/16/73) *Construction must comply with 11 her applicable State and local regulations
LOT AREA
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P =171
DAVIE COUNTY HEALTH DEPARTIMENT
P . 0. BOX 57
I40CKSVILLE, N. C. 27028
(7 04) 634-5985
Statement for Septic Tank Improvement Permits '
and/or Site Evaluations
NAiwE ,, . ..., /�4- DATE ISSUED �-
ADDRESS PERMIT N0.
Explanation of charge /� ,-,, ;, `•_
AMOUNT DUE ,- `i , SANITARIAPI
PLEASE REMIT THE ABOVE AHOUNT ON RECEIPT OF THIS STATEMENT/
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