142 or 177 Cub Creek LnDAVIE 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 r 1 DATE PERMIT
LOCATION
N9 1620
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE [3MOBILE HOME LJ BUSINESS E
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES 0 NO 0"
AUTO. DISHWASHER YES Q NO [3
AUTO. WASH. MACHINE YES NO 0
SITE SUITABLE YES NO, ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual 0 Public 0
IMPROVEMENTS PERMIT BY
CERTIFICATE OF COMPLETION
By—
(8/16/73) *Construction must comply with all
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
I
applicable State and
local
reg dations
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� �%; ��.f fF r���� DATE ISSUED
ADDRESS PERMIT NO.
Explanation of charge
--
AMOUNT DUE SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.