P1910 Turrentine Church RdDAVIE COUNTY HEALTH DEPARTMENT
. - (Septic Tank) Improvements Permit and Certificate of Completion
(Gr%undjAbsorption Sewage Disposal System - G.S. Chapter 0- rticle 13C)
OWNER OR CONTRAObTOR ��j/V % �,,..,, r..:., DATE5� PERMIT
LOC T 0
!%!!,E'P X0,1 le It S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE 0- MOBILE HOME 0 BUSINESS ❑
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO
AUTO. DISHWASHER YES Q NO
AUTO. WASH. MACHINE YES ET'- NO ❑
SITE SUITABLE YES E�r'NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public L7
IMPROVEMENTS PERMIT BY %��f
CERTIFICA
(8/16/73)
LOT AREA
TE OF COMPLETION
By
*Construction must comply with a
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 800-Ga.l. 600 Sq. Ft.
Three Bedroom House 900 Gal. 900 Sq. Ft.
Four Bedroom
House 10 0 Gal. 1200 Sq. Ft.
x/s/.0/
INSTALLED BY
1' 4 Dc IV( ff (Y.V 0 Date_+
other applicable State and local
t•egurations
* e .4
_ DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absor t"jp ewajpFoi ,5a System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR fJ-/-L- l Tic:DATE ` PERMIT
LOCATION f F =' Y ;rf `7 s ;mss ` r^�`'f {:. N� 1910
S.R. NO.
SUBDIVISION NAME
LOT NO. SECTION OR BLOCK NO.
HOUSE p"- MOBILE HOME ❑ BUSINESS
NO. BEDROOMS " NO. BATHROOMS /
GARBAGE DISPOSAL UNIT YES ❑ NO 0
AUTO. DISHWASHER YES ❑ NO Q
AUTO. WASH. MACHINE YESQ "ANO ❑
SITE SUITABLE :�,�r ~� YES ❑- NO ❑
SIZE OF TANK `G gal.
NITRIFICATION FIELD sq. ft.
r
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑, Public Q
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
10Q0
Gal.
1200
Sq.
Ft.
lr t
INSTALLED BY
CERTIFICATE SOF COMPLETIONBy !t'(E !�r (i Date '617?
(8/16/73) *Construction must comply with a other applicable State and local regulations
LOT AREA
pot.
' ;,
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
NA14E i��Lt DATE ISSUED��
ADDRESS 7} / PERMIT N0.�
Explanation of charge "
AMOUNT DUE SANITARIAN
PLEASE REMIT THE ABOVE A14OUNT ON RECEIPT OF THIS STATEMENT.