169 Turrentine Church 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 _+ `' a DATE '-' �-w''rf !%` PERMIT
LOCATION `r i ti lr 1860
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 [3— -' Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO ❑"` Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES Cl' NO ❑
$ITE SUITABLE YES ❑ NO ❑ r
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
i
WATER SUPPLY: Individual. ❑ Public
IMPROVEMENTS PERMIT BY / :: .- ��' '� - •-''l INSTALLED BY
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must comply with all otl4er applicable State and local regulations
LOT AREA
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I '
\\ DAVIE COUNTY HEALTH DEPARTMENT
P . 0. BOX 57
I4OCKSVILLE , N. C . 27028 ,X
eJ ' Q
� (704) 634-5985
Statement�;,for Septic Tank Improvement Permits
` andjor Site Evaluations
NAME �% -�--% � 7 DATE I,SSL�ED // ���• U
ADDRESS �\, �. , yJ„{ . � PERMIT NO . 4 , !
T— 1
Explanation of charge / ( �:,h- -✓ ? �a c7,r�,r.-�. �:, /,-r-='%t��
AMOUNT DUE SANITARIAPI
PLEASE REMIT THE ABOVE A14OUNT ON RECEIPT OF THIS STATEMENT.