P1959 Sain Rda T
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 DATE PERMIT
LOCATION N? 1959
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME [!I--BHS-1-NESS ❑
NO. BEDROOMS NO. BATHROOMS /_
GARBAGE DISPOSAL UNIT YES ❑ NO 0—
AUTO. DISHWASHER YES ❑ NO Q'"
AUTO. WASH. MACHINE YES 6 -'NO ❑
SITE SUITABLE YES [3---90 ❑
SIZE OF TANK �G -'i�� gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public
IMPROVEMENTS PERMIT BY 1 /,6,
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 ^�
B Da
(8/16/73) *Construction must comp -' y with all other applicable State and local regulations
LOT AREA
'J
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 � i7/ DATE ISSUED
ADDRESS � 7 PERMIT NO. �7
% r
Explanation of charge ,, 11,14
AM0UNT DUE SANITARIAN / ^`
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.'