131 Wildwood Ln 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 14 3 4
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
N0. BEDROOMSI 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 ev. vL.I'u9--v ^- -,,� N $,- ab-77
SITE SUITABLE //�� YES [3 NO ❑ � 4,. bj%jV,- q""' "ill-- wa. , ,tum-•1L•G
SIZE OF TANK OOP gal. 1
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: /fY"'ICae1
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY <:._ INSTALLED BY
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
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DAVIE COUNTY HEALTH DEPARTMENT ,�1,14
P . 0. BOX 57 Q l9�
MOCKSVILLE , N. C . 27023
(7 04) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME LV%O,, a �'G' DATE ISSUED�r�l _'L7
ADDRESS R�,�t, 3 PERMIT NO. _
Explanation of charge
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AMOUNT DUE S,0 SANITARIAN � nna,,b
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.