132 Latham Farm Rd (2) ' 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 PERMIT
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LOCATION N° 1986
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S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS ❑
: House Trailer 800 Gal. 400 Sq. Ft.
N0. BEDROOMS N0. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES I2" NO ❑ Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES (2" NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES NO ❑ t r t ti,.-•; ,( .. S ti i c a �c.,r j c
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
,�S�J:. , S.l T'•�)t ��� ,'.+.1 �:J"gyp '� �i + ' �
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual 0' Public ❑
IMPROVEMENTS PERMIT BY `�, . ' t --- t
�' INSTALLED BY {
CERTIFICATE OF COMPLETION Bye l �� a. Date �S 7?
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
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DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57 l
MOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME MATE ISSUED 0-,2.2-2P"
ADDRESS /cf/(f SCrr - 1t_7 �1Le,r,,,L PERMIT NO. /
Explanation of charge /-�,Qz,�.+;. ;�•�,,,;,
AMOUNT DUE /s'c*� SANITARIAPI
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.