P2324 Sanford Ave DAVIE COUNTY HEALTH DEPARTMENT -
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note.I§sued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name ' -- -- Date _ r
c.
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 p NO p"
Necificatio s r System:Auto Dish Washer YES 0 NO p 1700X_�F J
Auto Wash Machine . YES p NO
i
Type Water Supply —/
*This permit Void if sewage system described below is not/installed within 36 months from date of issue.
41
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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 1:0071:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: ystem Installed by
Certificate of Completion Date l
"The signing of this certificate shall indicate that the system described abo 4e 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
r"
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note`7"ssued.in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit. Number
Name Date
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size �%` '< House Mobile Home _ Business Speculation
No. Bedrooms �-F No. Baths v No. in Family
Garbage Disposal YES ❑ NO ID 7 Specificatio s for System: . r✓,s-�:!%<<=
Auto Dish Washer YES p NO E] Ij �' p�j�I ' nE
Auto Wash Machine YES [h ,NO ❑
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
i
r
- 1
Improvements permit by r �
*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.
1
Final Installation Diagram: ystem Installed by _
r �
1
Certificate of Completion �'=` ^' i Date �l
*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 COMITY HEALTH DEPARTIMIT
PERCOLATION TEST RESULTS
DATE...
l
LOCA i IOaI� L11l�(--
c
FINDINGS: HOLE 110.
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3 ✓� ��.�.�� /_ 'fir- ,�-�- ®� �'� .�°
� i� � � ��' �'✓ ��G° s�Ali�af�/�
By:
J
LOT DIAG.''.MI— �
"
02
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DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
MOCKSVILLE, N. C . 27028
(7 04) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAP,:E ��, /`s} � !';' DATE ISSUED,,/
ADDRESS -�'`,,' ;✓ .�i`fc�� �. �` �'i�''+�r PERMIT NO.
ter" '��'•�.�"'r'`i''l""'
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Explanation of charge •?�s �f � f , :� ,•�r���, r ,.s�.'.r
AMOUNT DUE%� .�. �� SANITARIAPI
PLEASE REMIT THE .ABOVE A14OUNT ON RECEIPT OF THIS STATEMENT.