174 Westridge Road Lot 42;DAME COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion .
.;�•�
"%(Ground'AbsoMtion Sewage Disposal^$ystem . G.S. Chapter 130 -Article 13C)
QWNER OR CONTRALTO "A � tr ,� �� DATE /,0� - PERMIT
LOCATION N�'1598
S.R. NO. -
SUBDIVISION NAME W44.A `
w. LOT NO. -a SECTION OR BLOCK NO.,
.HOUSE MOBILE HOME BUSINESS ❑
:NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO E:r,.
AUTO. DISHWASHER YES f NO . Q
AUTO. WASH. MACHINE: 'YES Er NO ❑ .
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal..
NITRIFICATION FIELD- sq. ft.
DEPTH OF STONE IN LINESs
.WATER SUPPLY: Individual.' ❑ ` Public,
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.
So
INSTALLED BY ,
DAVIE COUNTY HEALTH DEPARTMENT �%74
P. 0. BOX 57
MOCKSVILLE, N. C. 27028
(7 04) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAM' -'�„ 0 r�;� ��,_� _ DATE ISSUED/,,,—W
ADDRESS ;� It e.`� c.. ! I,ra,.__,1_A PERMIT NO.
Explanation of charge
Y
1 r
AMOUNT DUE', /" •c/3 SANITARIAPJ _j@)
L/
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.