P1817 Prison Camp RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter,130-Article 13C)
?OWNER OR CONTRACTORDATE r' f 5' PERMIT
Y � O..
LOCATION t;' - , : / ;:�' !.' - r �. fit`! 181
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE
HOME
❑
BUSINESS ❑
_«_..
"
House Trailer 800
Gal.
400
Sq.
Ft.
NO. BEDROOMS
NO.
BATHROOMS
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 Q�
Four Bedroom House 1000
Gal.
1200
Sq.
Ft.
AUTO. WASH. MACHINE
YES
NO ❑
SITE SUITABLE
YES
D
NO ❑
l
SIZE OF TANK
gal.
iP
t
NITRIFICATION FIELD
sq. ft.
l�✓� �. f j,, Y^
`.
DEPTH OF STONE IN LINES:
Z_
WATER SUPPLY: Individual
❑
Public ❑
�``��•-
rlL
iw,F :rs do -
IMPROVEMENTS PERMIT BY
.F�
' '
INSTALLED BY
CERTIFICATE OF COMPLETION
BY—
(8/16/73) *Construction must
LOT AREA
Date to- IS -1?
.Dly with all other applicable State and local regulations"'-:.,
Fatt %
r
J
t {
t 19J(
I .� t
DAVIE COUNTY HEALTH DEPARTMENT
r�
P. 0. BOX 57
MOCKSVILLE, N. C. 27028��
(704) 634-5985
Statement for Septic Tank Improvement Permits
,. and/or Site Evaluations
NAP41E �, Y ��,; „�'1n.�` DATE ISSUED � l
ADDRESS PERMIT NO. /I P7
Explanation of charge
AMOUNT DUE, SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.