P2527 Dogtrot Rd r
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 tiJr I �( (, r 1 Date 2,_r..
Location
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Subdivision Name Ir L o. Sec. or Block No.
Lot Size t"� ' ` House Mobile Home _ Business Speculation
No. Bedrooms No. Baths Z--~ No. in Family
4E
Garbage Disposal YES ❑ NO �j]
Specifications for System:
Auto Dish Washer YES ] NO ❑ 1
,
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Auto Wash Machine YES [ NO F-11�` ..�_ 1�- (�.�
Type Water Supply C_ c .s N j _— -f1 u `. .1j
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Tl.
r
y'1 ' Improvements permit by
( I I •'
*Contact a representative of the Davie �ount) Health Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day o, completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by
4V `o 14
61
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Certificate of Completion �� Date
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*The signing of this certificate shall indicate that the system descriped 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; COUIJTY HEALTH DEPARTMENT
PERCOLATION TEST RESULTS
DATE
NA.niE 4 Ap6Ltt
LOCATIO�d 60( S 6a 7rc'-)fc2'n Fc> Z< 3W-T 224�)
FINDINGS: HOLE NO. CO:i:^'lENTS
�. 2 `�i1��L. ib;ov 12 S-nzfa�f
� , 'Qv f N a T l►^ti t H
3S4,r„
4
5
6
By:
a
LOT DIAGRWI
I ,
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O ll,
1
DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION p
• �a-----" . P.O. BOX 57
-' MOCKSVILLE, N.C. 27028 �
(704) 634-5985
STATEIENT FOR SEPTIC TAMC I11PROVEMENTS PEILMITS AND/OR SITE EVALUATIONS
NA14E 'j" a NG lt,. DATE
ADDRESS;. PEP14IT NO.
EXPLANATION OF CHARGE 1 VAt(/ 77gJ �-
AtMOUNT PjQ_M_" SANITARIA
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.