P2279 Sanford Ave 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 t �r�'}lf�r. � t`ftr, ),=+/i^� Date
Location
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 p%r
Specifications for System:
Auto Dish Washer YES NO ❑ , „ _
Auto Wash Machine YES ❑p NO ❑
Type Water Supply
*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 �' �' Date
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*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
ENVIRONMENTAL HEALTH SECTION
P.O. BOX 57
MOCKSVILLE, N.C. 27028
(704) 634-5985
STATE11EN ' FOR SEPTIC TANK IMPROVEMENTS PERMITS AND/OR SITE EVALUATIONS
C
NAPS lneA4J6 ; �i� l DATE
ADDRESS /,rte 'Y SAL / PERMIT NO.
EXPLANATION OF CHARGE /
AMOUNT DUE SANITARIAN
PLEASE RE12MIT THE ABOVE AMOUNT OF RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be completed until payment is received.
Improvements Permit(s) can not be issued until payment is received.
DAVIE COUTIMY HEALTH DEPARTMENT
PERCOLATION TEST RESULTS
DATE
NAME io�!/L'/���L�//�
LOCATION s �/
FITIDINGS: HOLE N0. COMMITS
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LOT DIAGRAMS
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1
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2
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3