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165 Raintree Road Lot 8p . DAVIE COUNTY HEALTH DEPARTMENT —,; (Septic Tank) Improvements Permit and Certificate of Completion (.Ground Absorptio Sewage$isposal � stem-,� G.S. Chapter 130 -Article 13C) OWNER OR CONTRACTOR / r S QTc (!a DATE 5&,,V7;? -PERMIT LOCATION ©` e� 4l��yL ��N9 1826 S.R. NO. SUBDIVISION NAME % ;¢rte,, i1 ., �S/ �'t ! LOT NO. 8 SECTION OR BLOCK NO. -- HOUSE HOUSE ©' MOBILE HOME ❑ BUSINESS ❑ NO. BEDROOMS NO. BATHROOMS / GARBAGE•DISPOSAL UNIT YES L'J NO ❑ AUTO. DISHWASHER YES i�'INO ❑ AUTO. WASH. MACHINE YES NO ❑ SITE SUITABLE YES ❑ NO ❑ SIZE OF TANK gal. NITRIFICATION FIELD sq. ft. DEPTH OF STONE IN LINES: WATER SUPPLY: Individual ❑ i0uglic ❑ IMPROVEMENTS PERMIT BY House Trailer 800 Gal. 400 Sq. Ft. Two Bedroom House 800 Gal. 600 Sq. Ft. Three Bedroom House 900 Gal. 900 Sq. Ft. Four Bedroom House 1000 Gal. 1200 Sq. Ft. INSTALLED BY CERTIFICATE OF COMPLETION By Date _ (8/16/73) *Construction must cr y wi 11 other applicable State and local regulations LOT AREA 41 l� DAVIE COUNTY HEALTH DEPARTMENT A - (Septic Tank) Improvements Permit and Certificate of Completion (Groun4 'Abnrptio Se age ,isposal stem,. G.S. Chapter„ 130- rticle 13C) OWNER' OR CONTRACTOR /\ }"= " cS/�Ga-e�YJit DATE I<v PERMIT LOCATION ©`y«cct�-� N9 1826 S.R. NO. SUBDIVISION NAME ,.• s � LOT NO. 8 SECTION OR BLOCK NO. i HOUSE ©' MOBILE HOME ❑ BUSINESS ❑ N0. BEDROOMS 4/_ NO. BATHROOMS GARBAGE•DISPOSA'L UNIT YES 011, NO ❑ AUTO. DISHWASHER YES (/NO [:3AUTO. WASH. MACHINE YES [g" NO ❑ SITE SUITABLE YES ❑ NO ❑ SIZE OF TANK gal. NITRIFICATION FIELD sq. ft. DEPTH OF STONE IN LINES: �o WATER SUPPLY: Individual ❑ Pugl 7 ❑ IMPROVEMENTS PERMIT BY /)(.'Ivqv CERTIFICATE (8/16/73) LOT AREA House Trailer 800 Gal. 400 Sq. Ft. Two Bedroom House 800 Gal. 600 Sq. Ft. Three Bedroom House 900 Gal. 900 Sq. Ft. Four Bedroom House 1000 Gal. 1200 Sq. Ft. INSTALLED'BY OF COMPLETION By ` ,�.�� Date *Construction must omp y wi 11 other applicable State and local r gulations YY� DAVIE COUNTY HEALTH DEPARTMENT P. 0. BOX 57 MOCKSVILLE, N. C. 27028 (7 04) 634-5985 Stateent for Septic Tank Improvement Permits --and or Site Evaluations NAPI:E ,' S2.0✓,,�-� DATE ISSUED ADDRESS ��(} � �,,�yj-�--� ) jl,{,u,�,. P E R IYI I T N 0 . Explanation of charge 1. ._ . `moi r `i%. � �..� • ' � r AMOUNT DUE � --' SANITARIAN t PLEASE REMIT THE ABOVE A14OUNT ON RECEIPT OF THIS STATEMENT.