178 Juney Beauchamp Rd t DAVIE COUNTY HEALTH DEPARTMENT �►'�4/P.cf �QG��C(:YIGL�YiP -
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR ,Re eq R4 Zkc `',iv DATE ,�� /�' 7.5r PERMIT
LOCATION 153>1 - ' .�:1;, �1L v�i, <., �t c he_c 4 c. N? 564
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer 8
N0. BEDROOMS �, N0. BATHROOMS Two Bedroom House 00 Ga 600 S Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ N0 [:] Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES & NO ❑
SIZE OF TANK gala
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: /;Ale- �eoX3,C�pr,�ati. •.141
WATER SUPPLY: Individual ® Public ❑ d 1 "�s j oc�t 3'X`�'
IMPROVEMENTS PERMIT B ; t*N'N,c,. ,r.; INSTALLED BY Lot
CERTIFICATE OF COMPLETION By �` Date
(8/16/73) *Construction mustkiomply with all other applicable State and local regulations
LOT AREA 'S'1- A C7�Z F a V C"
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