1493 Underpass Road Lot 15DAVIE 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 DATE PERMIT
LOCATION t N9 1480
S.R. NO.
SUBDIVISION NAME ;'; t LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME ❑ BUSINESS
N0. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD 00. sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Q Public ❑
IMPROVEMENTS PERMIT BY rI I
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 ry
By Date
(8/16/73) *Construction must comply with all chber applicable State and local regulations
LOT AREA
J
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME *bA,,d F'shk DATE ISSUED 7- /- -7
ADDRESS 94. 7 'Bq( o- qO PERMIT N0, I�ZFv
Explanation of charge
AIdOUNT DUEjC�, l(b SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.