235 Westridge Road Lot 19DAVIE 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 �',� ,..,, L s .t .[i i r.. •-:;'z . `�c� • a DATE PERMIT C
LOCATION �J �` 1675
7
5
S.R. NO.
SUBDIVISION NAME l,ji;" " ,; LOT NO. SECTION OR BLOCK NO.
HOUSE 0- MOBILE HOME U BUSINESS C7
NO. BEDROOMS -' NO. BATHROOMS '""
GARBAGE DISPOSAL UNIT YES ❑ NO ❑-
AUTO. DISHWASHER YES C1 NO ❑
AUTO. WASH. MACHINE YES tn- NO ❑
SITE SUITABLE YES ( NO ❑
SIZE OF TANK UD gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public
IMPROVEMENTS PERMIT BY t '!"`" t' ` `•=
CERTIFICATE OF COMPLETION 1y� r6p
By
(8/16/73) *Construction must comply with
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
Date `f� 7
Ll other applicable State and local regulations
cess
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 (',.: ,.�►.i� (`�„_ 1. E��,• DATE ISSUED �117ii
ADDRESS PERMIT NO.
Explanation of charge-,ti{;,�,>T,,;. ^, �,. -4s 1`1 U.s..
AM0UNT DUE SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.