468 Dulin Rd 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 DATE PERMIT
LOCATION Y
' N° 1461
f 1
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 [a Four Bedroom House 1000 Gala 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑ -- �� wA
SITE SUITABLE YES ❑ NO EDAf U&A'
SIZE OF TANK.':: gal. `r`'� Qa Q ( - 3-3-77.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: �I
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY c" ' INSTALLED BY
CERTIFICATE OF COMPLETION By • (l — a 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. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
;
NAME on',"', (&--a lj,, y�c�� DATE ISSUED
(,•�A•r7
ADDRESS cn � � `�O7 A PERMIT NO. 146f
Explanation of charge /— ln ,�,u►. ��
AMOUNT DUES SANITARIAN
PLEASE REMIT THE ABOVE AHOUNT ON RECEIPT OF THIS STATEMENT.