P2671 Joe Rd DAVIE COUNTY HEALTH DEPARTMENT ----9
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
`Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
• Permit Number
Name C�, i Ji `t t=!fir
Date
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Location _
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Subdivision Name \1 Lot No. Sec. or block No.
Lot Size House Mobile Home_ Business Speculation
No. Bedrooms 171 No. Baths i No. in Family
Garbage Disposal YES ❑ NO [ Specifications for System: S"oo
Auto Dish Washer. YES ❑ NOp
Auto Wash Machine YES ❑ NO p f�`�� r j 7Z, z
Type Water Supply tJ`r �_. --
`This permit Void if sewage system described below is not installed within 36 months from date of issue.
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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 byA 11L' I L-Lk1 Rp
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Certificate of Completion5 G% 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 COUNTY HEALTH DEPARTMENT
PERCOLATION TEST RESULTS
DATE- 3 — 10 g
NAME GAS b-q-4,t-J N v-, 1 $ 407 7
LOCATION �l �. (UfL-n1 Y-C w Ar,?5 C7�)
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FINDINGS: HOLE NO. COIIENTS
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DAVIE COUNTY HEALTH DEPARTMENT
ENVIR01114EIlTAL HEALTH SECTION
- P.O. BOX 57
MOCKSVILLE, N.C. 27028
(704) 634-5985
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STATEMENT FOR SEPTIC TA14K IMPROVEMENTS PERMITS AND/OR SITE EVALATiONt- ..
NAPIE DATE ..2
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ADDRESS 9— , � f ga% i Z f� PERMIT NO. -
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EXPLANATION OF CHARGE 1 i�,�� JA Ly&_w...
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AMOUNT DUE__ZDyV SANITARIAN
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.
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