P1943 Davie Academy RdDAVIE 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'ta, .,, r, i ;b r,, t 7%, N? 1943
-7
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME E3-- BUSINESS
NO. BEDROOMS a
NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES El NO 0
AUTO. DISHWASHER YES 0 NO 0
AUTO. WASH. MACHINE YES 0 NO 0
SITE SUITABLE YES [3 NO [3
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ED,"'Public
IMPROVEMENTS PERMIT BY
CERTIFICATE OF COMPLETION
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
A
Date .40 A-26 4
local '
(8/16/73) *Construction M with all 17 other applicable state and reguYations
LOT AREA
L
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 iG
NAME r� f1n,F5 Flit, l[4..Q_ 4�:,-(� �":r��, DATE ISSUED/,-)-/,/,
d�
ADDRESS PERMIT NO. / 413
Explanation of charge
AA4OUNT DUE-g-2SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON.RECEIPT OF THIS STATEMENT.