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1005 Fork Bixby 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 Name1 '%i._' •1 =� r'�� Date2276 Location 77777 �f Subdivision Name Lot No. Sec. or Block No. Lot Size `' House Mobile Home — Business Speculation No. Bedrooms %vJ No. Baths No. in Family Garbage Disposal YESNO �' ,r` �� ! f Specifications for System: Gu Auto Dish Washer YES ©--'NO E] r' - ✓� Auto Wash Machine YES p-0 p �-% �✓. -= r Type Water Supply *This permit Void if sewage system described below is not installed within 36 months from date of issue. t 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: System Installed by 9,-R, ^ 1 Certificate of Completion Q `>1c �� 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. DAVIE COMMIT HEALTH DEPARTMENT PERCOLATION TEST RESULTS DATE NAME LOCATIOi1 �� FIIIDI14GS: HOLE 110. COMMITS yC 2 611,Y 0,4 By: LOT DIAGI I d © p � Z � J, DAVIE COUNTY HEALTH DEPARTMENT P. 0. BOX 57 ��. ° MOCKSVILLE, N. C . 27028 (704) 634-5985 r Statement for Septic Tank Improvement Permits and/or Site Evaluations NAME DATE 'ISSUED , ADDRESS PERMIT NO. Explanation of charge , 'f AMOUNT DUE SANITARIAPd PLEASE REMIT THE ABOVE A14OUNT ON RECEIPT OF THIS STATEMENT. rye . oue 1