362 River Road Lot 25DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground'Absorp ion Sewage. Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR l;^ �e t..d.k i�,.,.:,�# ..'c�• DATE %4 PERMIT
LOCATION(P N? 1678
S.R. NO.
SUBDIVISION NAME !� at: ,r,. r i.. LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME ❑ BUSINESS ❑
NO. BEDROOMS 14" NO. BATHROOMS '
GARBAGE DISPOSAL UNIT YES ❑ NO 0"
AUTO. DISHWASHER YES [ NO ❑
AUTO. WASH. MACHINE YES L -i' NO ❑
SITE SUITABLE YES Q� NO ❑
SIZE OF TANK %" gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public Er"-'
IMPROVEMENTS PERMIT BY
CERTIFICA
(8/16/73)
LOT AREA
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
INSTALLED BY
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
�, . t�• Y1'iCn�.
OF COMPLETION"
Date 1 /a 31?1
*Construction mustucomply with all other applicable State and local regulations
"�� X x
• y,
V
DAVIE COUNTY HEALTH DEPARTMENT �r
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME (Af %� i„ '��,. i' 1,�%DATE ISSUED 3),,7177 "'
e
ADDRESS �- ,=' ` ;� PERMIT NO.
Explanation of charge i .,,_ i - ����-i__ c_,s ,�,a=_ �S 0-1Q
AMOUNT DUE i.'-. (n
SANITARIAN r,_ . ;�•.,; ., �;�_
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.