P2208 Mocks Church Rd 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 Date
Location2 '
Subdivision Name Lot No. Sec. or Block No.
I;
Lot Size I ' �' " House Mobile Home _ Business Speculation
No. Bedrooms No. Baths j No. in Family t ��
Garbage Disposal YES p NO Q-
Specifications for System: t,
Auto Dish Washer YES p- NO p
Auto Wash Machine YES p NO p
Type Water Supply 1 A r -- • =/,I, / ,.�" /, :_,!- / ,.- . ,� ._
'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 by
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Certificate of Completion T Date -
'The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards se?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 COUi3TY HEALTH DEPARTMENT
PERCOLATION 'PEST RESULTS
DATE 7—S 79
NA.TtE Aw4e 3_ I�7oc L'sa://G — 99� — Sfc3o
LOCATIOzd
FIMINGS: HOLE 140. CO:MENTS
16411,
3
4
5
6
LOT DIAG.WL I,
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DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
� SC
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
-1 NAIKE` cAA�
Mtjc-k DATE ISSUED -7Is17f
ADDRESS PERMIT NO.
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Explanation of charge
AMOUNT DUE o"7a•cy SANITARIAN, n1
PLEASE RE14IT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
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