P1915 Hwy 801NDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage,Disposal System - G.S. Chapter 130 -Article 13C)
4
OWN91K G:8 CONTRACTOR ;' ! ::f;^+^. %/ 'r f,�
DATE PERMIT
LOCATION 1., ,,, . �� it : ; .. P�
O
:' f .>, r lr . 1915
t
r. ?;. ,,, f. ✓ —� : l S.R. NO.
SUBDIVISION NAME LOT NO.
SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
NO. BEDROOMS NO. BATHROOMS
House Trailer 800 Gal. 400 Sq. Ft.
_ _
Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑-----
Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO ❑
Four Bedroom House 1000 Gala 1200 Sq. Ft.
AUTO. WASH. MACHINE -YES,_2' NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
t/✓. !' .+ f
"
DEPTH OF STONE IN LINES:
✓ _i ., y - -��-�
WAT6 SUPPLY: Individual Q"''Vublic ❑
✓�'f%''
_ /�
IMPROVEMENTS PERMIT BY
INSTALLED BY�-/�-
CERTIFICATE OF COMPLETION
By
Date
(8/16/73) *Construction must comply with all
/ther applicable State and local regulations
LOT AREA
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. B O X 5 7y -t" x
MOCKSVILLE, N. C. 27028
(7 04) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAP�:E DATE ISSUED
. erre �'! % �/� .��
ADDRESS PERMIT NO.
Explanation of charge % �•,,�,v�,��„-
AMOUNT DUE %� SANITARIAN.
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.