721 Richie Rd (2) DAVIE tCOUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground AbsorRtti/on Sewa a Disposal ystem, - G.S. Chapter 130-Article 13C)
OWNER„OR CONTRACTOR /`7 ! � » .�.tTG`�a} DATE PERMIT
�:b �,rr �, f N� 1662
LOCATION ,) . y !!
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE. HOME E3 BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
N0. BEDROOMS N0. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES �NO ❑ ThreefBedroom House ., 29D-„G1. 900 Sq. Ft.
AUTO. DISHWASHER YES Cg--9'0 ❑ Four `Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES J:3,-190 ❑ f /t
SITE SUITABLE YES 0,--NU" ❑
SIZE OF TANK ( gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: ,,^140-4
'
WATER SUPPLY: Individual Public ,�❑
IMPROVEMENTS PERMIT BY y =! INSTALLED BY
CERTIFICATE OF COMPLETION By Date!���'��'-��
(8/16/73) *Construction must comply w14 all other applicable State and local regulations
LOT AREA
V
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028 I
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME r'/t�( ::'�= %� /:_/..�Lc`C,c'/lG�'7 DATE ISSUED
ADDRESS 'i ?� ._�C� / f PERMIT NO. �'�--
,�'3
Explanation of charge -~%• G'«';�_ <' �=' `t'=`: C`�x�''��
-2/
AMOUNT DUE h� SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.