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160 Double A Trail DAVIE COUNTY HEALTH DEPARTMENT:- 4, IMPROVEMENTS PERMIT AND' CERTIFICATE OF COMPLETION `Note:j sued in Compliance with G.S. of North Carolina Chapter 130—Article lac s - Permit `Number Name t1•� { 'r rcd� ,��.c^ j A `Date, 7 S" 7`i � 0 2206 Location. 00,1{e, b • '- .�✓��.J vr� �� cn . [ �euT Subdivision Name' Lot No. Sec. or Block No. Lot.Size at House X Mobile Home Business Speculation No. Bedrooms No: Baths No. in Family Garbage Disposal. ;YES C NO ]�" Specifications for System: �ac� gip•1« �. • Auto Dish Washer!: YES.©" NO fl Auto Wash Machine AYES 'p- N0 Type Water Supply C Un,� Mei CSA,4, •JOL t. ,K c� c . �w• �;z, ,- Q. 1 4- *This permit Void if sewage system described below is not installed within 36 months,from date, of issue. �. � it r _ ^� _' :.. � � • i� Improvements permit by ' �1 V *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. j - Final Installation Diagram'7. S/y tem Installed by Axit FALL It Certificate of Completion Date y "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 COUiJ+.'Y HEALTH DEPARTMENT PERCOLATION TEST RESULTS DATE NILK LOCATION /�,L':�, U4/le, FIIIDI14GS: HOLE 140. COMMITS HITS a _ z_ �� /a7o ten;-� e � CIL." � 4� 3u� / 6 LOT DIAG,'2 UM C��Wa Ito Ile J DAVIE COUNTY HEALTH DEPARTMENT P. 0. BOX 57 q MOCKSVILLE, N. C. 27028 `? "a ' 7 ` (704) 634-5985 (� Statement for Septic Tank Improvement Permits and/or Site Evaluations NAME ►�A�lr�.Q_l�R,� �, DATE ISSUED ADDRESS PERMIT NO. Q-ao(o Explanation of charge I aA .1• d w.�?�• (0 A11OUNT DUE A.9-aa SANITARIAN ' PLEASE REMIT THE ABOVE ANOUNT .ON RECEIPT OF THIS STATEMENT.