P1771 Angell RdCERTIFICATE OF COMPLETION By & A -7' . Man -.
Jo - Date
(8/16/73) *Construction must comply with al_ l/other L'applicable State and local regulations
LOT AREA
1301
;Jill
A
DAVIE 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
1771
S.R. NO.
SUBDIVISION NAME
LOT NO.
SECTION
OR BLOCK NO.
HOUSE 0 MOBILE HOME 0 BUSINESS ❑
House Trailer
800 Gal. 400
Sq.
Ft.
NO. BEDROOMS
NO. BATHROOMS
Two Bedroom House
800 Gal. 600
Sq.
Ft.
GARBAGE DISPOSAL UNIT
YES 0 NO ❑
Three Bedroom House
900 Gal. 900
Sq.
Ft.
AUTO. DISHWASHER
YES 0 NO 0
Four Bedroom House
1000 Gal. 1200
Sq.
Ft.
AUTO. WASH. MACHINE
YES ❑ NO ❑
SITE SUITABLE
YES [3 NO [3
SIZE OF TANK
gal.
NITRIFICATION FIELD
sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual
-
0 Publ'ic'e❑
IMPROVEMENTS PERMIT BY
INSTALLED BY
CERTIFICATE OF COMPLETION By & A -7' . Man -.
Jo - Date
(8/16/73) *Construction must comply with al_ l/other L'applicable State and local regulations
LOT AREA
1301
;Jill
A
citl\ .C�P�Q
DAV
IE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
k4OCKSVILLE, N. C. 27028 1
(704) 634-5985
Statement for.Septic Tank Improvement Permits
and/or ' to Evaluations
/-�
/l7FNAE ��-�DATE ISSUED
/
ADDRESS l 11/ d ;PERI,iIT NO. 1711
XJC.
Explanation of charge
AMOUNT DUE SANITARIAN�'�'
PLEASE RE?JIT THE ABOVE�AHOUNT ON RECEIPT OF THIS STATEME T.