P2570 Pudding Ridge 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 i
Name /,//,Jr:%C' /'r°/y1/1 //ZDate% �: < f ` ;''� r�'- � 0
Location
(Y r
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 ❑' Specifications for System: f
Auto Dish Washer YES ❑ NO fl-'
Auto Wash Machine YES ❑ANO p
Type Water Supply , _.r'+ _ F` f`,
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
i
c 1�
T1
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 'Jt
LSct.-
f
I
Certificate of CompletionZ Date` 12 "
'The signing of this certificate shall indicate that the system descried 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
PERCOLATION TEST RESULTS
DATE
NAME- ��f(l
�� � '" �V
61
LOCATION � � '-
FINDINGS: HOLE NO. C01,24ENTS
r1livi. Ao , 6p
r
By:
LOT DIAGM-1
J
.; DAVIE COUNTY HEALTH DEPARTMENT ; ~� •;
(V/
ENVIRONMENTAL` HEALTH SECTIOIl
P. 0. BOX 57
{ ,k„ MOCKSVILLE, N.C. 27028
,. (704) 634-5985
Statenent'Xor S tic Tank Improvements Permits and/or pit E aluad ons
000
i tl
IWIE y' �/.!%� DATE
DDRESS ;"' w` PEPMIT 140.el
EXPLANATION OF CHARGE ✓� .%�i
,,
AMOtTeJT DUE_�i 'r/,► SANITARIAN
j
PLEAE, REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEi4ENT.
! *NbTICE:. Evaluations) can not be completed until payment is received.
Inprd'Vemsnts Permit(s) can not be issued until payment? is rec(aived
f