P2495 Seaford Rd DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note"Assued t.n.Compliance,with G.S. of North Carolina Chapter.130—=Article 13c.
• - / ---- --Permit�Number
Name /i �t�' dfl /s�.�a/ Date ��� ! 49
Location /�' � 1 c�i/(�,' f'.�,� r� ✓ �ri'i�t.�G'i�GsJ "'" %� �"
t 61ke✓,/A
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" Specifications for System:
Auto Dish Washer YES NO p
Auto Wash Machine. -YES NO ❑ r
Type Water Supply
Y *This permit Void if sewage,sy tem 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.
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Final Installation Diagram: System Installed by Cil
v 11;, y
Certificate of Completion Date
'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.f&any given period of time.
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DAVIE COUNT HEALTH DEPARTAMNT
PERCOLATION TEST RESULTS
DATE
LOCATION ,
FINDINGS: HOLE 140. COMMENTS
2
3
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5
6
By:
LOT DIAGWl
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DAVIE COMITY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
P. 0. BOX, 57
MOCSSVILLE, N.C. 27028-
(704)
7028(704) 634-5985
Statenent `for Septic Tank Improvements Permits and/ S e v 1 ones
C,L/
! ATE s
NAME �C KSS i ?✓ D
ADDRESS PERMIT NO. `' E
EXPLANATION OF CHARGE
* td�JGrI
AMOUNT DUE +�`� `� SANITARI --
PLEASE REMIT THE ABOVE A11OUNT ON RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be completed until paynent is received.
Improvements Permit(s) can not be issued until payment is received.