360 Boxwood Church RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Dis 1 Syslem -JO.S. Chapter 130 -Article 13C)
INER OR CONTRACTOR
Y
DATE PERMIT
N9 1494
/LOCATION P -d
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE
NO. BEDROOMS :z
GARBAGE DISPOSAL UNIT
AUTO. DISHWASHER
AUTO. WASH. MACHINE
SITE SUITABLE
SIZE OF TANK
BUSINESS
NO. BATHROOMS
YES
0
NO
0 '
YES
Cl.-,
NO
E3
YES
Ej
NO
rl
YES
[3
NO
[3
ga 1.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public
IMPROVEMENTS PERMIT BY
House Trailer 800 Gal.
Two Bedroom House 800 Gal.
Three Bedroom House 900 Gal.
Four Bedroom House 1000 Gal.
7T,
INSTALLED BY 'S - —
-,,- , % - C,, .—
CERTIFICATE OF COMPLETION y CL., Date
(8/16/73) *Construction Mu'st comoy with all other applicable State and local regulations
LOT AREA
....... ...... ..... .. . '_
400
Sq.
Ft.
600
Sq.
Ft.,
900
Sq.
Ft - '
1200
Sq.
Ft. --
INSTALLED BY 'S - —
-,,- , % - C,, .—
CERTIFICATE OF COMPLETION y CL., Date
(8/16/73) *Construction Mu'st comoy with all other applicable State and local regulations
LOT AREA
....... ...... ..... .. . '_
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
11OCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Eva at 1-/,2-7
NAME DATE ISSUED 10f(
ADDRESS PERMIT NO.
pr\,tla, a3-1 -
Explanation of charge
AMOUNT DUE P SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.