268 Watt St DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage/�,D,,isposal System - G.S. Chapter 130-Article 13C)
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OWNER "OR CONTRACTOR "4/I� S �//C(/4-ey DATE PERMIT
LOCATION 1739
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME 0 BUSINESS Q
t House Trailer 800 Gal. 400 Sq. Ft.
N0. BEDROOMS N0. 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.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ ubli' ❑
IMPROVEMENTS PERMIT BY INSTALLED BY
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CERTIFICATE OF COMPLETION By'^ ey a, c , Date
(8/16/73) *Construction mu:rt- comply 'vX—th--W other applicable State and loc u tions
LOT AREA
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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
ADDRESS PERMIT N0.
Explanation of charge
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AMOUNT DUE octi�, SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT �OF THIS STATEl4ENT.