1049 Ben Anderson Rd DAVIE COUNTY HEALTH DEPARTMENT:I- .
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IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
`Note: Issued in Compliance with G:S. of North Carolina]Chapter 130—Article 13c j
Permit Number
Name f t� i'71.�/ %'"/ �/,�.� i Date �` $ _' 8
Location
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Subdivision Name ill Lot No. SI c: or Block Ni
Lot. Size House Mobile fll ome L - U
� II �Business �{" ' Speculation
No. bedrooms = No.-Baths No. in Family
Garbage Disposal YES fl-e NO ❑
Specifications for System:
Auto Dish Washer YES ❑ NO;��] y ;�� .,
Auto Wash Machine YES Q NO ❑ r/' ®Pr.
Type Water Supplyr
"This permit Void if sewage system described below isinstalled.installed.within 36 months from date of issue.
. i
,Improvements permit by Illi, r
"Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-
9:30 A.M. or-1:004:30 P.M. on. day.of completion. T Illephone Number: 704-634-5985.'
Final Installation Diagram:. System Installed by
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# A75
Certificate of 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
satisfactorily for any given period of time �':.
DAVIE COMITY HEALTH DEPARWIENT
PERCOLATION 'PEST RESULTS
DATE
NAPM
LOCATION
FINDINGS: HOLE PIO. C0b1cWTS
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By:
LOT DIAGIWI
II
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DAVIE COUNTY HEALTH DEPARTMENT
P . 0. BOX 57
MOCKSVILLE, N. C . 27028
(7 04) 634-5985
Statement for Septic .Tank Improvement Permits ;
and/or Site Evaluations
NAME /�'/�, %, J r� �/ ,-rte- DATE ISSUED �✓�
ADDRESS/� �(G� PERMIT NO.
Zg!/�Z- &z 4��—
Explanation of charge
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AMOUNT DUEL-C> SANITARIAN
PLEASE REAMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.