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1489 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 NaMb- j ''Date F-' 27¢' Location Subdivision Name Lot No. Sec. or Block No. Lot Size i!'r House Mobile Home _ l Business Speculation No. Bedrooms No. Baths No.No. in Family Garbage Disposal YES ❑ NO © Specifications for. System: Auto Dish Washer YES ❑ NO p Auto Wash Machine YES ❑'ANO ❑ `', 'f- %'• Type Water Supply _— *This permit Void if sewage system described btelow is not installed within 36 months from date of issue. Y f � 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: ooi System Installed by', Certificate of Completion '� Date�n *The signing of this certificate shall indicate that the system describLt above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be as a guarantee that the system will function satisfactorily for any given period of time. DAVIE COUr?TY P.EALTH DEPARTHENT ENVIROV1ENTAL HEALTH ,SECTION SOIL/SITE EVALUATIOP IIAME rte/ ADDRESS LOCATIO1.14 1 r/ LOT SIZE TOPOGRAPHY: SOIL TE:ITURE: SOIL STRUCTURE: DEPTH: RESTRICTIVE HORIZOES: PERCOLATION PATE: Presoalc Turk & time Dro Time Pate iir.. Inch 1. 2. 3. ***CLASSIFICATIOIT:Suitable �vrovi Suitable~ Unsuitable � o b COMMITS: j 75 0,11 c SANITARIAM SITE 'DIAGPA:' DAVIE COUr?TY P.EALTH DEPARTHENT ENVIROV1ENTAL HEALTH ,SECTION SOIL/SITE EVALUATIOP IIAME rte/ ADDRESS LOCATIO1.14 1 r/ LOT SIZE TOPOGRAPHY: SOIL TE:ITURE: SOIL STRUCTURE: DEPTH: RESTRICTIVE HORIZOES: PERCOLATION PATE: Presoalc Turk & time Dro Time Pate iir.. Inch 1. 2. 3. ***CLASSIFICATIOIT:Suitable �vrovi Suitable~ Unsuitable � o b COMMITS: j 75 0,11 c SANITARIAM SITE 'DIAGPA:' DAVIE COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION P.O. ,BOX 57 MOCKSVILLE, N.C. 27028 (704) 634-5985 STATEMENT FOR SEPTIC TA14K II1PROVEME11TS PERMITS AND/OR SITE EVALUATIONS r NAME .�r�li'�.' i;j✓`,r.it- �f`..'J�f �/�:.fii' DATE ADDRESS PEP14IT NO. • f � EXPLANATION OF CHARGE , J�'; %' '' :" lvr,,• r,', :,; Ile , AMOUNT DUE -"r 1_ n O SANITARIAN ,r-��•C�..� PLEASE REMIT THE ABOVE AMOUNT OF RECEIPT OF THIS STATEMENT. *NOTICE: Evaluation(s) can not be completed until payment is received. Improvements Permit(s) can not be issued until payment is received. DAVIE COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION P.O. ,BOX 57 MOCKSVILLE, N.C. 27028 (704) 634-5985 STATEMENT FOR SEPTIC TA14K II1PROVEME11TS PERMITS AND/OR SITE EVALUATIONS r NAME .�r�li'�.' i;j✓`,r.it- �f`..'J�f �/�:.fii' DATE ADDRESS PEP14IT NO. • f � EXPLANATION OF CHARGE , J�'; %' '' :" lvr,,• r,', :,; Ile , AMOUNT DUE -"r 1_ n O SANITARIAN ,r-��•C�..� PLEASE REMIT THE ABOVE AMOUNT OF RECEIPT OF THIS STATEMENT. *NOTICE: Evaluation(s) can not be completed until payment is received. Improvements Permit(s) can not be issued until payment is received.