P2576 Laird Rd DAVIE COUNTY HEALTH DEPARTMENT L�r �.
$' IMPROVEMENTS PERMIT AND CERTIFICATE- OF COMPLETION ..
`Note: Issued..in Compliance with G.S. of North Carolina.Chapter 130—Article 1'3c.
-Permit_Number
Name �;G! llGi'v Date n §�"�h2,5
76
Location 1 i/&"�' i rte; Irl .� �,a Qr.✓ ,. %- t r.,�' ( _ ,C
Subdivision Name Lot No. Sec. or Block No.
Lot Size/��`j5 7) -House -;'Mobile Home._ Business Speculation J
No. Bedrooms ; _ No. Baths f No. 'in Family
Garbage Disposal YES ,E] NO p ;+ Specifications for System:
Auto Dish Washer YES E NO p r ; ✓'
Auto Wash Machine YES ❑ NO ;ZX
Type Water _Supply ,;_., - '
• `This permit:Void if sewage system described below is not installedwithin 36 months from date of issue.
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!Improvements permit by
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*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 RM. on day of completion. Telephone Number: 704-634-5985.
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Final Installation Diagram: stem Installed by
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Certificatealof Completion 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 a
satisfactorily for any given period of time. j;,I
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DAVIE COUNTY HEALTH DEPART14ENT
PERCOLATION TEST RESULTS
DATE
NAME
LOCATION
7
FINDINGS: HOLE NO. COIR ENTS
57
2.
4.
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BY.
LOT DIAG
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