184 Daisy 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
, c � hrtitDA_ TE_ CnP.s. t�7yU7. t PERMIT
LOCATION � Gt ., 1 — I O f n
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11 S. . NO.
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SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME FZ 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 ET Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES C2r NO ❑
4k SITE SUITABLE YES C3" NO ❑
SIZE OF TANK 97> gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY INSTALLED BY
4
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
(Septic Tank) Improveilhents hermit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR DATE PERMIT
LOCATION N? 1445
S .R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME 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 Er' NO ❑ (r�,�edwa'l- 9
SITE SUITABLE YES ED" NO ❑ `��p �,L � s`-31-��
SIZE OF TANK -t13 gal.
NITRIFICATION FIELD sq. ft. Q A ,
DEPTH OF STONE IN LINES: � � �,��,, ;, �, �;� �..� Poi✓'^
WATER SUPPLY: Individual 1p Public ❑
IMPROVEMENTS PERMIT BY �` INSTALLED BY
CERTIFICATE OF COMPLETION By ry)
Date
(8/16/73) *Construction must cVmply with all other applicable State and local regulations
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DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
5
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME �O�e� `��� �� DATE ISSUED,.g±.Z7
ADDRESSP`,:6 :1 2XIj -3 PERMIT NO. --
Explanation of charge
1-�c-q----, yr AlQ�tr.r4�i'
AMOUNT DUE 1a SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.