P1503 Junction RdDAVIE COUNTY HEALTH DEPARTMENT
(Seutic Tank) Improvements Permit and Certificate of Completion
(Ground Abso6tioii Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR DATE l PERMIT
LOCATION
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SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME Q BUSINESS ❑
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO Q.
AUTO. DISHWASHER YES ❑ NO Q
AUTO. WASH. MACHINE YES 0 --NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK "I.;_.� (') gal.
NITRIFICATION FIELD sq. ft.,
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ['
IMPROVEMENTS PERMIT BY
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 1009 Gal. .r,1200 Sq. Ft.
INSTALLED BY
Cie
CERTIFICATE OF COMPLETION By Date Z&y122
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
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DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
MOCKSVILLE, N. C. 27028
(7 04) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAMEr'
ADDRESS
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Explanation of charge_
DATE ISSUED
PERMIT NO. /
P
J Jle-
AMOUNT DUE SANITARIAN,
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.