P2283 Gladstone Rd 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 1i //�d 1r� .:{ Date
-' '�1- f`•.Y;' a
>> 2283
Location f� /� 5 �✓1�' �r�'f! . / St ,f�,' E r �!�, � 07
Subdivision Name' Lot No; Sec. or Block No.
Lot Size '- -' -House `'' "' MobiliPHome`' Business —_ Speculation
No. Bedrooms- No. Baths _ No.'in Family
Garbage Disposal /`,YES, NQ; E2 _�•.' f�-1 ��
Specifications .for System:
Auto-Dish Washer' YES EP NO
r
Auto Wash Machine ES NO 0. �`f /Xl
Type Water .Supply �2� ---
-*This permit Void if sewage system described belowis not.installed within 36 months from date of issue.
1 Improvements permit by
*Contact a representative .of the Davie. County Health Department for final inspection of this system between
9:30 A.M. or 1:00-1:30.P.M; on.day of completion;: Telephone Number: 704-634-5985.
Final Installation Diagram:. System Installed by4 S i• 4�
r _
Rf`"f i Certificate of Completion Q Date/� ,612 9
The signingyof'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. s
Y
DAVIE COUNTY HEALTH DEPARTMEUT
PERCOLATION TEST RESULTS
DATE
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LOCATIOiI
FINDINGS: HOLE 110. COIAIME dTS
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LOT DIAGIWI
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DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONME14TAL HEALTH SECTION S
.A ., P.O. BOX 57
MOCKSVILLE, N.C. 27028
(704) 634-5985 Ib �
STATEMENT FOR SEPTIC ANK IMPROVEMENTS PERMITS AND/OR SITE EVALUATIONS
NAME DATE /fie" /���' 00
ADDRESS PERMIT NO. I ?
EXPLANATIO14 OF CHARGE
015
AM4OUNT DUE SANITARIAN
__;?�V/
PLEASE REMIT THE ABOVE AMOUNT OF RECEIPT OF THIS STATEMENT.
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*NOTICE: Evaluation(s) can not be completed until payment is received.
Improvements Permit(s) can not be issued until payment is received.