1150 Cana 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)
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OWNER OR CONTRACTOR J7`ri /ri % �'-� DATE "J ,i'' PERMIT
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LOCATION R' _
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N9 1542
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME E3 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. j
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑
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IMPROVEMENTS PERMIT BY INSTALLED BY Ala Z43:4
CERTIFICATE OF COMPLETION By Date
(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. SOX 57
MOCKSVILLE, N. C. 27028
(704) 6345985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAPfE i DATE ISSUED ' /'61
ADDRESS �/u �/�• �' c'c� ! Uri PERMIT NO .
Explanation of charge
AMOUNT DLA v-b SANITARIAN 17
1 T. R r
PLEASE REMIT THE ABOVE A14OUNT ON RECEIPT Ty
TE ENT.
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