281 Double A Trail (2) 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. IA,ez f� tom Date i i t:t
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i:
Location !�:r;;ii. 1
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home Business __ Speculation
No. Bedrooms No. Baths No. in Family _
Garbage Disposal YES ❑ NO 0--
Specifications for System:
Auto Dish Washer YES E' NO ❑
Auto Wash Machine YES ElNO ❑
Type Water Supply t") C ( ( __—
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by
rr
*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.
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Final Installation Dia�j am: System Installed by ��s�i�
G1
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 COUNTY HEALTH DEPARTMENT
IMPRIOVEMENTS PERMIT AND!j
CERTIFICATE.,OF COMPLETION
Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c. i
Permit Number
9 �.
Namet P� C , Date f/u4�r 5/; 225.4
- Lk
Location (l14,-111. f�G
Tji
Subdivision Name ii tot.No. �� Sec' or Block No.
Lot Size -33aCLeAJ House Mobile Home k Business I Speculation
, li
No. Bedrooms 3 I� No. Baths No. in Family II
Garbage Disposal IYES 0 NO p'' Specifications for System: .�U�S
Auto Dish Washer N YES NO ❑ li; II ' 4���- S �w�G
i Auto Wash Machine YES NO
Type Water Supply
`This permit.Void if sewIge system described below is not.installe'd within 36 months from date of issue.
w
i 1 I II V
I, i
. I;
Improvements permit by i • �
*Contact a represetative of the Davie County Health Department for final inspection f this system between.;8:30-
9:30 A.M. or 1:00 1:30 Il.M. :on day of completion. Telephone Number: 7041634-5985.?'
Final Installation Dia am: 'System Installed. by
. (JAW
Is
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i
Certificate of Completion III t 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: I�'
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
tak �_,G�,S;ii ff� x.41 ? 2? 4
Name r_�3 Date f
` . i p
Location
Subdivision Name II Lot No. Sec. or Block No.
Lot Size ..
House Mobile Home Business Speculation
it
` No. Bedrooms No. Baths - No. in Family
I
Garbage Disposal YES C NO E]--
II Specifications 'for System: .qu�
Auto Dish Washer YES NO
Auto Wash Machine YES NO. C] ���� �G crc
.Type Water' Supply
II f
'This permit Void if sewage system described below is not installed within 36 months from date of issue.
u
it
I „
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h
II Improvements permit bY J,
,
*Contact a representative of the jDavie County Health Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 PIM. ori, day of completion. Telephone Number: 704-634-5985.
Final`Installation Dia am: I! System Installed by
u
�. q
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;,tlat the system will function
satisfactorily for any given period of_time. i
'J
DAVIE COU11MY HEALTH DEPARVIENT
PERCOLATION TEST RESULTS
DATE`O�dd l 7 / �9?_
NAIX (r; 1 m A 0 t
LOCATION ( a i��
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FINDINGS: HOLE NO. COMMENTS
�n�Qgt�reSoc�R'c0 �l���g ' r� l
3taA Z. /� 1 711, �lU4n.y1 L/pcaunJ�
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3 of /azo�5`/Cr- a o R oa
afCJ�c�L 7 30- 33
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By:
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LOT DIAGiZAM
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DAVIE COUNTY HEALTH DEPARTMENT - (� . 011
P. 0. BOX 57
MOCKSVILLE, N. C . 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
n and/or Site Evaluations
NAME (: ,I� ��., �,;��,.� DATE ISSUED 75
ADDRESS PERMIT NO.
Explanation of charge ; 5•.;..
AMOUNT DUE ,�t�.v� SANITARIAPI
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.