P1752 Hwy 601SDAVIE 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 N° 1752
S.R. NO.
SUBDIVISION NAME
LOT NO.
HOUSE ❑ MOBILE HOME [T BUSINESS ❑
N0. BEDROOMS ;I NO. BATHROOMS f
GARBAGE DISPOSAL UNIT YES ❑ NO ❑'
AUTO. DISHWASHER YES ❑ NO ❑_
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES D NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY!1-->
SECTION OR BLOCK NO.
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
(3 -5?e?-.
Z
INSTALLED BY
CERTIFICATE OF COMPLETION
By Date
(8/16/73) *Construction must comply with,all other applicable Statt- and local regulations
LOT AREA
r i+
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
MOCKSVILLE, N. C. 27028
(704) 634-5985pg ��,I-y3v�
1
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAP -4E � .�, ,n, � �,u�� _. DATE ISSUED
ADDRESS i�,� p J ,G ` PERMIT NO.
U Al 0,
Explanation of charge I44 44 9
AMOUNT ,DUE/J " SANITARIAN
PLEASE REMIT THE ABOVE A14OUNT ON RECEIPT OF THIS STAWHENT.