268 Seaford Rd ~ DAVIE COUNTY HEALTH DEPARTMENT _- - _ -
ed,
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
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*Note:.Issued '6'-Compliance with G.S. of North Carolina Chapter 130--Adic|e 13c.
Permit Number
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Location -Ti
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Subdivision Name Lot No. Seo. or Block No.
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Lot Size House __� Mobile Home ____ Business ____ Speculation
No. Bedrooms No. Baths No. in Fomi|y- ____-
Gorbage Disposal YES ;E] NO Specifications for System: '-J'6(_)
Auto Dish Washer YES [] NO E]
Auto Wash Machine YES [j] NO F]
Type Water Supply
*This permit Void if sewage system described below is not installed within 38 months from dote of issue. '
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Improvements permit by
°Contoota 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 b
Certificate of Completiol/ Datel
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'The signing of this certificate shall indicate that dxe system described has been installed in compliance with
the standards set forth in the above nagu|a1iun, but ahoU in NO way betaken as aguarantee that the system will function
satisfactorily for any given period oftime. `
DAVIE COUNTY HEALTH DEPARTMENT
PERCOLATION TEST RESULTS
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DATE
NAME U-aS-f--f f--k -P1 C- (T
` LOCATION
FINDINGS: HOLE NO. COMIENTS
00
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4.
S.
6.
By:
LOT DIAG
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r , DAVIE COUNTY HEALTH DEPARTMENT �� '
.. K i'( l�N,t 'T ..,
&VI NMENTAL HEALTH SECTION "
P. 0. BOX 57
MOCKSVILLE, N.C. 27028-
(704)
7028(704) 634-5985
Statement for Septic Tank Improvements Permits and/or Site Evaluations
NAbIE , DATE •.I 1 . >
ADDRESS lit , t>J i�- 1`- :- t : PUZIT 140. r
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EXPLANATION OF CHARGE L ��� %i rl.ti. i ,"�{r /�f �'Ir
�77'i� y•'ti1 1J♦
At40UrJT DULL} >C.�.`�� SAtJITARIAN :>
PLEASE REMIT THE ABOVE A1OUNT ON 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.