550 Beauchamp Rd (3) 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 � �L�:`�.-. f 1/ _. .(l.(, DATE PERMIT
LOCATION !. �5 r;., �' i r/, ; ;_�✓ Ctv` -' :c_,,.t,! % , . ... -�,. .. Jr,. �r�( .
` 1975
S.R. NO.
SUBDIVISION NAME , LOT NO. SECTION OR BLOCK NO.
P.
'HOUSE (] MOBILE HOME Ej BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS -' 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 ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑ _
SITE SUITABLE YES Q NO ❑ j `. �.,.�
SIZE OF TANK,,—
NITRIFZ TI (FI l�' . ,,,�''' t% sq. ft. ✓3 �_.
DEPT,,HHH��-�Qy STONE IN. ISS.
WATER SUPPLY: :-2nd vidual ❑ Public- ����
IMPROVEMENTS PERMIT BY J 2Ltt INSTALLED BYL'�=Lcf
CERTIFICATE OF COMPLETION By i' Date r17 F
(8/16/73) *Construction must comply with all otAer applicable State and local regulations
LOT AREA
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DAVIE COUNTY HEALTH DEPARTMENT �-
P. 0. BOX 57
HOCKSVILLE, N. C. .270285
(704) 634-598
Statement for Septic Tank Improvement Permits
and/or/fSite Evaluations - 7
NAME ���iC /�'l �'I/ DATE ISSUED / 7
ADDRESS PERMIT NO. f
Explanation of charge
AMOUNT DUE , SANITARIA!f�,
PLEASE RE14IT THE ABOVE AMOUNT ON-;RECEIPT OF THIS STATE T% NT.