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109 Guinevere Ln • 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 LOCATIONN? 1936 f� ,14 r'< �, ! /, .'r {,-!i` S.R. NO. SUBDIVISION NAME LOT NO. ' SECTION OR BLOCK NO. HOUSE ❑ MOBILE HOME BUSINESS ❑ ,I �fI- House Trailer 800 Gal. 400 Sq. Ft. NO. BEDROOMS C'� 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 ❑ IO Ea—_ Four Bedroom House 1000 Gal. 1200 Sq. Ft. AUTO. WASH. MACHINE YES 0—'NO ❑ �� SITE SUITABLE YES ©''ANO ❑ -ra,. %• SIZE OF TANK gal. NITRIFICATION FIELD sq. ft. ,�'w= s � v�.✓" DEPTH OF STONE IN LINES: fr i WATER SUPPLY: Individual ❑ Public IMPROVEMENTS PERMIT BY _ ,"' INSTALLED BY CERTIFICATE OF COMPLETION By Date (8/16/73) *Construction must comply with all other applicable State and local regulations LOT AREA �� i. DAVIE COUNTY HEALTH DEPARTMENT P. 0. BOX 57 HOCKSVILLE, N. C. 27028 (704) 634-5985 /Statement for Septic Tank Improvement Permits }�� a and/or Site Evaluations NAME DATE�/ ��i�'I DATE ISSUED : ADDRESS �4 J ,/ PERMIT NO. Explanation of charge AMOUNT DUE 1, SANITARIAN PLEASE REMIT THE ABOVE. AHOUNT ON RECEIPT OF THIS STATEMENT.