P105 Howardtown RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
�_- (Ground Absorpt on Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR
; DATE PERMITLOCATION
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oi'fQ JCc�. r � 1 1 a s e O N Le rT', l� 9 105
tl
S.R. NO.
.SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS c NO. BATHROOMS
Two Bedroom House 8 1.Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
Three Bedroom House 900 �Ga 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO ❑
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK, ) Q� ga 1.
µ e- h - /4
%!e �y r q�
NITRIFICATION FIELD�QI.'sq. ft.
VQ i` I `44 o owc
DEPTH OF STONE IN LINES: y c �j
11 G u d" C W,` �/� A rt 4e e e� �p6
WATER SUPPLY: Individual Public ❑
I �'ab 5%✓G lPa 1";
IMPROVEMENTS PERMIT BY c /
INSTALLED BY
CERTIFICATE OF COMPLETION
BY—
(8/16/73) *Construction must
LOT AREA
Date
with aff other applicable State and local regulations
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DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorpt on Sewage Disposal System - G.S. Chapter 130 -Article 13C)
11
OWNER OR CONTRACTOR ,; : re, , r �` e' , �.� .yea DATE � • / �� i,�� PERMIT
y 1/1 , t. .� N° 105
LOCATION /-A C- ,moo n�`� %�? f_s� its ,x'J• t,^�� r-1,
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME W BUSINESS ❑
NO. BEDROOMS 3 NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD r.sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
c
IMPROVEMENTS PERMIT BY
CERTIFICATE OF COMPLETION
BY—
(8/16/73) *Construction must
LOT AREA
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 800._Ga'1. 600,Sq. Ft.
Three Bedroom House900„Ga,l. 900)Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
rL+ J Date
with a].T other applicable State and local regulations
�A1
cv
DAVIE COUNTY HEALTH DEPARTMENT
Jwner/Occupant
Address 3�
SEPTIC TANK PERP,1IT
To:
Address
Building Contractor Address
Cal. 200 Manufacturer's Name Address
No'. of lines Width in. Total length
Type of filter material
Total tons used
Date 4—/-- �-�L
ft. No. sq. ft.
Minimum REquirements: House Trailer Tank cap. 800 Sq. ft. line 400
Two-bedroom house 800 600—
Three-bedroom house900 Qf)
No one shall install a septic tank in Davie County without a permit from the Health Offic
or his agent.
Date of Final Approval Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specification
Signed:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.