309 Armsworthy Rd �
� DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter13O--Adic|e 13o. �
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Permit Number
Name Date
Dabe
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Subdivision Name Lot No. Sec. orBlock No
Lot Size `1 House /-''~ Mobhy Home __ Business ___ Soaou|obon ---__-_-_
No. Bedrooms No. Baths "Nu in Family-
Garbage Disposa
omily______GurbaoeDin000a YES Ej NO -
Au|nDiohWaaher YES NO [�
Auto Wash Machine YES r.-I N[) -F]
Type Water Supply
*This permit Void if sewage system described below in not installed within 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 P.M. on day of completion. Telephone No-mber: 704:.634-5985-
Final Installation Diagram: Svstern Installed..by-
Y-}/>/|'
1_---Certificate of Completior� Date 4
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'The signing of this certificate aho|| indicate that the described above been installed in com '|ianms with
the standards set forth in the above nagu|a1ion, but shall in NOway betaken as guaranteethat the system will function
satisfactorily for any given period oftime. \
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DAVIE COUNTY HEALTH DEPARTMENT
PERCOLATION TEST RESULTS
DATE_ � �
NAME
LOCATION
v
FINDINGS: HOLE NO. COM4ENTS
2. �rC�v Hold•. ��t� �%o
• - f,��,i,•(�e�� PDQ ���~.
By:
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LOT DIAGRAI
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DAVIE COUNTY HEALTH DEPARTMENT
ENVIRON114EUTAL HEALTH SECTION
P.O. BOX 57
MOCKSVILLE, N.C. 27028 Q `� •�'
(704) 634-5985
STATEtIENT FOR SEPTIC TANK IMPROVEMENTS PERMITS AND/OR SITE EVALUATIONS
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e DATE
ADDRESS t �_� �yl� PERMIT NO.
EXPLANATION OF CHARGE
AHOUNT DUE , i !:: SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT OF RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be complated until payment is received.
Improvements Permit(s) can not be issued until payment is received.