P1433 Beauchamp Rd'•' 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 -' ; , i DATE i / PERMIT
LOCATION ► t� t _� i M 1433
' S.R. N0. /t,al
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE p MOBIL]
NO. BEDROOMS
GARBAGE DISPOSAL UNIT
AUTO. DISHWASHER
AUTO. WASH. MACHINE
SITE SUITABLE
SIZE OF TANK
NITRIFICATION FIELD
HOME ll BUSINESS
NO. BATHROOMS
YES ❑
YES ❑
YES ❑
YES ❑
ga 1.
NO 0
NO >❑°
NO Er
NO ❑
sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY '
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
INSTALLED BY -?Ct"l waSaS
CERTIFICATE OF COMPLETION BY 4 Date *T- C30-77
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA 7r, 6 + ,' i:. ' Y r (- G
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DAVIE COUNTY HEALTH DEPARTMENT
P. 0. B O X 57
MOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
n and/or Site Evaluations
NA14E R. VU:SA nSUVI- DATE ISSUED 5-1q"77
ADDRESS RNcAc, ; f64 lion 10 W,R-:3ohn5w•. PERMIT NO. I 3
Adtiar«
Explanation of charge ewtyvtc,4 R`rw:•�'
AMOUNT DUE Is�6' SANITARIAN CU -1-S
PLEASE RED-4IT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.