112 Juney Beauchamp Rd (3) "• as '� �
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 : .._f DATE i' i/' ,%' / PERMIT
LOCATION - F <f` N9 1649
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
N0. BEDROOMS '� House Trailer 800 Gal. 400 Sq. Ft.
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 p Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES NO ❑
SITE SUITABLE YES NO ❑
SIZE OF TANK gal. if ,
NITRIFICATION FIELD sq. ft.
. f
DEPTH OF STONE IN LINES: 16 r
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY / INSTALLED BY
j
t
CERTIFICATE OF COMPLETION
By � � Date -
(8/16/73) *Construction must comply with al yother applicable State and local regulations
,LOT AREA /
` rl/
l4 �J
DAVIE COUNTY HEALTH DEPARTMENT
P . 0. BOX 57
MOCKSVILLE , N. C . 27028 n
(704) 634-5985 V/C-
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAVE �, /Iti DATE ISSUED 11116 77
ADDRESS O PERMIT NO.
Explanation of charge
v
AMOUNT DUE , (J� SANITARIAN tZfK L
PLEASE REMIT THE ABOVE A14OUNT ON RECEIPT OF THIS STATEr NT.