130 Brookdale Dr Lot 11 Section 2DAVIE COUNTY HEALTH DEPARTMENT
6-• (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTORDATE PERMIT
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2000
S. R. NO.
SUBDIVISION NAME 4,Ze15 LOT NO. SECTION OR BLOCK NO. �4
HOUSE Q" MOBILE HOME ❑ BUSINESS ❑
4 House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS J NO. BATHROOMS a/ �— - Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO Er Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES 8 ' NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES J --r' NO ❑
SITE SUITABLE YES 0 NO ❑ Wd
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
atUD r� � a
DEPTH OF STONE IN LINES: ('uu
WATER SUPPLY: Individual ❑ Public
IMPROVEMENTS PERMIT BY INSTALLlEEDDD BY
CERTIFICATE OF COMPLETION
By Date
(8/16/73) *Construction must comply with all other applicable State and loca regulations
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"( - F DAME COUNTY HEALTH DEPARTMENT
(Septic Tank) `Improvements Permit
and ,Certificate of Completion
(Ground; Absorption Sewage Disposal System - G.S. Chapter 130 Article`13C).
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OWNER OR CONTRACTOR '�. ` �..°
DATE �'� , PERMIT,
LOCATION �' Ir d `, Wt"' '
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$
SUBDIVISION NAME �a_:; c LOT,, N0. .. SECTION OR, BLOCK NO
HOUSE. MOBILE HOME BUSINESS ❑ ,
s+,,
Housea Trailer $00 Gal% 400 "Sq F.t.:
NO. BEDROOMS 4 N0. BATHROOMS-
�?6 t`:�il
Two Bedroom House, 800 Ga1 00 S q F
- GARBAGE UN -IT YES 12 NO.
T-hruee Bedroom' House 900 Gal 900. .Et"°
,DISPOSAL-
AUTO,.DISHWASHER YES N0 �''.
Four Bedroom House 10,00 Gal ;.1200'Sq Ft'.
,,AUTO.,, WASH: MACHINE : - 9�YES NO'2 ❑
f,"
-SITE-'SUITABLE YES 0 NO
SIZE -OF TANK
ar
=NITRIFICATION FIELD sq. ft..
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DEPTH SOF .STONE:' IN LINES:
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;WATER SUPPLY. ,Individual. Public
MPROVEMENTS PERMIT tBY <� _. �.�ta w .
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INSTALLED. BY.' F
CERTIFICATE OF .COMPLETION'
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f. ay
.Date .. >
fi ' (8/1(,,'/73)°s•
*Construction° must comply with alit
other applicable and ioc regulations' h'
LOT AREA
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DATE /e %
NAIVE
DAVIE COUNITY HEALTH DEPART1,1ENT
PERCOLATION TEST RESULTS
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FITIDI IGS : S HOLE NO. COMMITS
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DAVIE COUNTY HEALTH DEPARTA'iENT 7
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME �• L �f1�► S , 70- DATE ISSUED /0-" 2r
ADDRESS �`� a\ L �. �`��A\`'C��n�..��.i �� PERMIT N0. o?ov U
-7y1�
Explanation of charge-
tj X, I \ is1-CK `�
AMOUNT DUE IS /Z) SANITARIAN }• �1
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.