P1439 No Creek Rdt DAVIE 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 - t DATE PERMIT
LOCATION Gtri-lo t r - ii j It t; i 7
O
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ® MOBILE HOME ❑ BUSINESS ❑
NO. BEDROOMS '� NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES Q. NO L1
AUTO. DISHWASHER YES Cj NO ❑
AUTO. WASH. MACHINE YES It NO ❑
SITE SUITABLE YES EJ NO ❑
SIZE OF,,,.TANK gal.
NIT~^FIATION FIELD sq. ft.
DEPTH"Ot SCONE IN LINES:
WATER SUPP,':Individual Public ❑
IMPROVEMENTS PERMIT BY
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
1435
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
L j
INSTALLED BY 154414".
CERTIFICATE OF COMPLETION 3 aY
(8/16/73)
LOT AREA
LAI" ^" Date " 7
*Construction must cNmply with all otpher,aa licable State and local regulations
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DAVIE COUNTY HEALTH DEPARTIMENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
t
and/or Site Evaluations
NAME s-��� `{�r�;'tt DATE ISSUED Y-;Zp•77
".ADDRESS (m;-- 3 PERMIT NO.
�11r�C�S�• Ite.
Explanation of charge �,. 'tt�.prw�r. ptitr►.��
AMOUNT DUL///S•yj SANITARIAN !-,
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.