154 E Robin Drive Lot 7DAVIE COUNTY HEAfH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System- G.S. 6Chapter 13,0-Axti le 13C)
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OWNER OR CONTRACTOR _c7t '7)Y-a'`fir; DATE. '`� '" ' z 0 ; PERMIT
� No
LOCATION 0/ +°) ;'J•:.. ifa ;. r.. f
S.R. N0,
SUBDIVISION NAME..'^(i, �::.�..� LOT NO. • SECTION OR BLOCK NO.
HOUSE MOBILE
HOME
❑
BUSINESS ❑
NO. BEDROOMS U
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 sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual IQ Public ❑
IMPROVEMENTS PERMIT BY�_
CERTIFICATE OF
By—
(8/16/73) *Construction must
LOT AREA
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
199
800 Gal. 400 Sq. Ft.
;.8on-
1000 Gal. 1200 Sq. Ft.
INSTALLED BY F11"J (J1
C: , {^ Date -a .S " / ;r
with all other applicable State and local regulations
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203.94
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DAVIE COUNTY HEALTH DEPARTMENT SEPTIC T/A,NnK` PEWIT Date
Jcmer/Occup t To: �� , i
Address4222AA�__Address
Building Contractor Address c 5:' j� S�
Cal. r4anufactu er's Name Address CX
No. of lines _ Width ?din. Total length 115-Z') ft. No. sq. ft.
Type of filter material Total tons used. cx7g6-- Z 2
Minimum REquirements: House TrailerTank cap. 800 Sq. ft. line 400
Two-bedroom hou 800 600
Three-bedroom hou 900 900
No one shall install a septic tank in Davie County without a permit from the Health Offic
or his agent. ;
Date of Final Approval Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specification
Signed:
k Septic T nk Contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.
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