2303 Milling Rd (2) DAVIE COUNTY HEALTH DEPARTMENT
k (Septic Tank) Improvements Permit and Certificate of Completion 7
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-A ti le 13C)
OWNER OR CONTRACTOR .�1 '�t ',4''u�&`Y DATE / ,f V,) ; PERMIT
LOCATION ' �/�L//'VC ,11 Cl-- i/ P ,vF C N? 1703
,ec/ oe, TL C'7e�= ,P 7,2177 S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS N0. 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 Q NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES C{] NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK al.
NITRIFICATION FIELD _ �Q/� sq. ft.
DEPTH OF STONE IN LINES: �
WATER SUPPLY: Individual ❑ Public ❑ ��ycP.aZ/ f �
IMPROVEMENTS PERMIT BY 2 INSTALLED BY
CERTIFICATE OF,COMPLETION By V �� f -,� ju,k, 6, Date / /. -177
(8/16/73) *Construction must comply wit all other applicable State and local regulations
LOT AREALj
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` DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion i-i•t; ,-'',%r
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR %+ % ` DATE C/ /2.-PERMIT
LOCATION J< /f. ` ;� r': J; %" ;• r:�; . _. N0 1703
:; i.r / r• S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
N0. BEDROOMS N0. BATHROOMS House Trailer 800 Gal. 400 Sq. Ft.
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. h
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY li r'::'c_ A r.' -"A' - / INSTALLED BY //�'Y71�" �j,�e �G r✓
CERTIFICATE OF COMPLETION
By Z Date /
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
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DAVIE COUNTY HEALTH DEPARTIMENT
P . 0. BOX 57 —7
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
11-)1127
NAME ;��e�E !, 4"AP ,V DATE ISSUED
I
ADDRESS � �-- PERMIT NO. 0`
Explanation of charge
�'- o-0
AMOUNT DUE �Ji �- SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.