P1941 Essic RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System G.S. Chapter 130 -Article 13C)
C
OWNER OR CONTRACTOR DATE PERMIT
LOCATION
N? 1941
S.R. NO.
SUBDIVISION NAME.,, LOT NO. SECTION OR BLOCK NO.
HOUSE Lj - MOBILE HOME 0' BUSINESS El
NO. BEDROOMS 11) " I .. ".'
NO. BATHROOMS I -
GARBAGE DISPOSAL -UNIT
YES
0
NO
ED
AUTO.
DISHWASHER
YES
0
NO
❑
AUTO.
WASH. MACHINE
YES
El
NO
❑
SITE
SUITABLE
YES
t
NO
[3
SIZE
OF TANK
gal.
NITRIFICATION FIELD - sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Indiviaua'l ❑ Public rl
IMPROVEMENTS PERMIT BY v
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
INSTALLED BY
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
CERTIFICATE.OF COMPLETION By_ /7
Date
(8/16/73) *Construction
must
��compj
comply wit
wi t�
ajj�
other
r� app
licab
le� State
te� an
d local regulations
LOT AREA
1=
DAVI E COUNTY HEALTH DEPARTMENT
P. 6. BOX 57
MOCKSVILLE, N. C. 27028
(7 04 ) 634-5985
Explanation of charge
N
4--,,,-;TMlOUNT DUE SANITARIAN
PLEASE REMIT THE,ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
Statement for Septic Tank Improvement Permits
and/or Site Evaluat'-ons
S ��
NA1,:E
DATE ISSUED
ADDRESS
PERMIT NO.
Explanation of charge
N
4--,,,-;TMlOUNT DUE SANITARIAN
PLEASE REMIT THE,ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
DAVIL COUIM. HEALTH DEPARTZMIQT
PERCOLATION TEST RESULTS
DATE IO A2 /7
NA.' -,2E �t��✓? �l�
LOCATION
MIDINGS :
LOT DIAGARMI
/ ROLE N0.
1
�/2
3
4
s _
6
C
0
COMISLITS