120 Raintree Court Lot 23. .
DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion . 3
(Ground Absorption Sewage Disposal System - G.S. Chapter 13 -Article 13C)
OWNER OR,.COO NTRACTORI f �f L 4.. DATE ' !`�1 r i PERMIIT
LOCATION ; ' i _ G, ,y, j` N9 1810
S.R. NO.
SUBDIVISION NAME 7ti�t % "r''r f LOT NO. L""SECTION OR BLOCK NO.
HOUSE C MOBILE HOME ❑ BUSINESS
NO. BEDROOMS &I NO. BATHROOMS s
GARBAGE DISPOSAL UNIT
YES
I]"
NO
❑
AUTO.
DISHWASHER
YES
Q'
NO
❑
AUTO.
WASH. MACHINE
YES
0",NO
1000
❑
SITE
SUITABLE
YES
0'
NO
❑
SIZE
OF` TANK
gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ _Public ❑
IMPROVEMENTS PERMIT BY
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
e
INSTALLED BY S�
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
t
.i
CERTIFICATE OF COMPLETION By Date 7
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA ��_
4'�y
G�
11
,, ft
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
MOCKSVILLE, N. C. 27028
(704) 634-5985 7 7�
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAPE �f �%S[- � G__ DATE ISSUED
ADDRESSn���%� PERMIT N 0 . Ov
Explanation of charge
9
AMOUNT DUE/ � , SANITARIAPJ��_��`'
PLEASE REMIT THE ABOVE A14OUNT ON RECEIPT OF THIS STATEMENT.