3859 Hwy 64W Lot 13"
DAMECOUNTY HEALTH DEPARTMENT
r .(Septic'Tank) Improvements Permit and Certificate of Completion
(Giound`Absorption-Sewage. Disposal S stem - G.S. Chapter 130 -Article 13C).,;
•I OWNER`,..ORSCONTRACTOR _ `. 4[vr- TA, - 1 N f i- K,
171
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LOCATION' to 4
_ S.R. NO:
SUBDIVISION NAME:, LOT NO.. i SECTION)OIC BLOCK NO.
HOUSE -0 MOBILE ROME 0 BUSINESS ❑
NO. - BEDROOMS ,, NO.' BATHROOMS
_ moi..:.._
GARBAGE'yDISPOSAL .UNIT YES ❑ NO
AUTO.'DISHWASHER s YES NO 0
:,'AUTO.- WASH. MACHINE YES NO ❑
SITE SUITABLE.: 4Y1 E3
-SIZE OF,_TANK,iJ
NITRIFICATION' 'FIELD sq. ft.
_DEPTH. AF'S TONE IN? LINES r
WATER.' SUPPLY:. :.Individual Public ❑ ' ,
,IMPROVEMENTS :PERMIT BY + '
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom Hous ej•. 800 .Gal; 600 Sq. Ft,
Three Bedroom:House 900 Gal. 900 Sq: Ft.
Four Bedroom.'House 10.0.0 Gal'.. .12.00 Sq. Ft.
66 1
INSTALLED BY P� _ •.
S
CERTIFICATE.OF COMPLETION'
BY"
Date
,
(8/16/73),.;` *Construction must.. comply
with all ther applicable State 'and local regulations
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DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
MOCKSVILLE, N. C. 27028
(7 04) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME �Qiyt,z ,%Q�z,c,l,Ji� DATE ISSUED
ADDRESS G� l PERMIT N0.1
`�'%�-c�
A/,, 7v a
Explanation of charge
AMOUNT
E -
DUJ,
SANITARIAN
11��
PLEASE REMIT
THE ABOVE A14OUNT
ON RECEIPT
OF THIS STAT MENT.