P1606 Rainbow 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 CONTRACTOR n C 1/ ;✓,3L_ /?,f- A!a �Q/✓ DATE 9130177
PERMIT
LOCATION -efl l N e o /J /e/N? 1606
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ C/ /,
HOME BUSINESS ❑
NO. BEDROOMS ccs'' NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO
AUTO. DISHWASHER YES ❑ NO
AUTO. WASH. MACHINE YES ❑ NO
SITE SUITABLE YES EEr NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: 1`p1
WATER SUPPLY:1 Individual ❑ Pub-IicrT ,A 13
IMPROVEMENTS PERMIT BY
rF.RTT FT rATF. OF
(8/16/73)
LOT AREA
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.
�'u d
C.Q7�/
I S"O -<2 X /
INSTALLED BY e &&e
---------- BY Date
*Construction must comply with all other applicable State and local regulations
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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 ! r' _', i , ✓ DATE %' t l % % PERMIT
LOCATION % ; lr 1606
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME ❑ BUSINESS
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO
AUTO. DISHWASHER YES ❑ NO Ej
AUTO. WASH. MACHINE YES ❑ NO []
SITE SUITABLE YES ❑f NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual_ ❑ Public((,� ❑
IMPROVEMENTS PERMIT BY JL .1 •. `� c �..Fk �_..
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 1000 Gal. 1200 Sq. Ft.
INSTALLED BY
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
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DAVIE COUNTY HEALTH DEPT.
PERK TEST RECORDS
DATE Ile -72_
NAME_-
LOCATION,��
3 ?ir
FINDINGS: HOLE NO.1 17 V ` /7 COMMENTS
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HOLE NO.2
HOLE NO. 17 le
LOT DIAGRAM
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DAVIE COUNTY HEALTH DEPARTMENT /
P. 0. BOX 57
MOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME &41j i�.���Q,���•,. /b lt-:�r�rt_ &41j DATE ISSUED 9,''G0'71
ADDRESS jT�-(^-�� -� PERMIT N0.
Explanation of charge/ -(,A
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AMOUNT DUE /6.00 SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.