186 Laird Rd " DAVIE COUNTY HEALTH DEPARTMENT
i (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR DATE - i 'I PERMIT
LOCATION 3, 1427
7r .E ,fi, tom'. 14, t � � + 't .~+, iMc'�;.-� S.R. NO
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME ja BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS M"' 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 (f Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑ �ucc�! (+- - "PC" l `
SIZE OF TANK gal'.
6-17-
77
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public`
IMPROVEMENTS PERMIT BY INSTALLED BY
CERTIFICATE OF COMPLETION
By 1W141 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 U�'`�G���.
P . 0. BOX 57 +/ l7)
MOCKSVILLE, N. C . 27023
(7 04) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME 'QQ�,�_�''�� �'�" DATE ISSUED 5 V77
ADDRESS PERMIT PERMIT NO . a 7
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Explanation of charge nA2 0yy%eQR,,TI;
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AMOUNT DUE#`S.6) SANITARIAN _ %
PLEASE RED41T THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.