359 Beauchamp Rd (2) DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name �' f7'1 Date ,UA712, t 559
Location ACo '
Subdivision Name Lot No. Sec. or Block No.
Lot Size/-R!-:?� 0 House Mobile Home ��.Business Speculation
No. Bedrooms _ No. Baths__ _ No. in Family
Garbage Disposal YES ❑ NO r]�� Specifications for ste : U
Auto Dish Washer YES ❑ NO fl 0, � ��
Auto Wash Machine YES p NO C]
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Q U)_J !l`. �
Improvements permit by
*Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: rSystenstalled by
i
Certificate of Completion Date
*The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
i 1k
DAVIE COUNTY HEALTH DEPART?AENT
PERCOLATION TEST RESULTS
DATE � �- �
NA14E
LOCATION
FINDINGS: J HOLE NO. C0114ENTS
3. Rle9
S.
6.
By:
LOT DIAGRAM
'L
d
DAVIE COUNTY HEALTH DEPARTMENT C'
ENVIRONMENTAL HEALTH SECTION
P. O. BOX 57
MOCBSVILLE, N.C. 27028-
(704)
7028(704) 634-5985
Statement for Septic Tank Improvements Permits and/or Te Eva ions
NAME ���/�� /0 'eA1A DATE. *1�0>Ae
ADDRESS 08� PERMIT 140.
V�
EXPLANATION OF CHARGE
A1400111T DUE SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluations) can not be completed.until .payment is received.
Improvements Permit(s) can not be issued until payment is received. .