204 Sunset Circle 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
0 111)
Name 4 r,�, : i� ,c:, � . Date �"� ? t
Location 1<,, f ti, i \ ,'R!` i z,� t .l t j:.,, :,
Subdivision Nam Lot No. Sec. or Block No.
Lot Size ` ' ° House Mobile Home — Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Dispose I YES ❑ NO ❑ Specifications for System: `'i`^ >
Auto Dish Washe YES gl- NO ❑ t z, , ;�J,' .. „o',? ,r,,
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Auto Wash Mach ne YES p' NO -❑
Type Water Sup ly t , ,- i. .,�
"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 repr sentative 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 Installatio Diagram: System Installed by B Pu citlms
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Certificate of Completion Date
'The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards et forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily fc r any given period of time.
DAVIE: COUPtTY HEALTH DEPARTMENT
PERCOLATION TEST RESULTS
DATE
(t�',lltnC Roams
NA.'"!E'
LOCAMOi1
FIND NG 5: HOLE 140. COMMITS
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DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
P. 0. BOX 57 f ,`
MOC&SVILLE, N.C. 27028, Pol. ►- /(N�'�
(704) 634-5985 r
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Statement for Septic Tank Improvements Permits and/or Site Evaluations
NAME Jti•a "D 4,►.s DATE V- 20-?0
ADDRESS 3�� PERMIT 140. oZ�gg
17oar
EXPLANATION OF CHARGE C►''�� tr °`D, -L' S ��'14.�VJr
AmOUIn DUE AO.eB SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be completed until payment is received.
Improvements Permit(s) can not be issued until pw1ment is received.