121 Guinevere Ln DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground A o tion Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACll�i("' ,'l� r"", DATE o�12�/7 8' PERMIT
f I �v -N° 1693
LOCATION X�lJ / '`fr/�: �" CF'° _"' /✓t r'��s. ,rl f i�` / � ' .� k
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
N0. BEDROOMS �.� N0. 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 Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES NO ❑SITE SUITABLE YES ❑ NO
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft. V�f✓ ,}/ ,/ � z-G�
DEPTH OF STONE IN LINES:
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WATER SUPPLY: Individual ❑ Public -j—// � - �_ +�,,•..
IMPROVEMENTS PERMIT BY GC , ,r � INSTALLED BY r r
CERTIFICATE OF COMPLETION
BY Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA j �,1 �,(,�jy►
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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 � ;, DATE ISSUED
ADDRESS PERMIT NO .z ZOLA
Explanation of charge
AMOUNT DUE SANITARIAN---!!�G7/
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.