165 Turkeyfoot Rd (5) Sr 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 t1 'u DATE 6, PERMIT
LOCATION
1850
j.- S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS NO. BATHROOMS 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. /
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑s Public ❑
IMPROVEMENTS PERMIT BY INSTALLED BY 009
7
CERTIFICATE OF COMPLETION
BY lCt.^+c�� - J��Cr!� _ Date/c 77
(8/16/73) *Construction musmply with all other applicable State and local regulations
LOT AREA o� (; 4 ( _ j ,/t,.rA 11
DAVIE COUNTY HEALTH DEPARTMENT
P . 0. BOX 57
MOCKSVILLE , N. C . 27028
(7 04) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME \ DATE ISSUED P
ADDRESS /� j _ ,� �i, j C� j PERMIT NO .
Explanation of charge
AMOUNT DU SANITARIAN-)'V}
PLEASE REA--IIT THE ABOVE AMOUNT ON RECEIPT OF THIS STR//
TEMENT."-