438 Underpass Rd 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
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Name AX
Date
Location —
Subdivision Name tot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family ~_ t
Garbage Disposal YES p NO D Specifications for System:
Auto Dish Washer YES [] NO p
Auto Wash Machine YES 0 NO p '
Type Water Supply E r`,�' c �. __ �• :.t , f=.
*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 -- f
*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�"y4
1/q �� l
Certificate of Completion ?" Date ` SO
"The signing of this certificate shall indicate that the system descr fed above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way pe taken as a guarantee that the system will function
satisfactorily for any given period of time.
DAVIE COMITY HEALTH DEPARTMiT
PERCOLATION TEST RESULTS
DATE
NA?'MA 110tV T%-P I L f-
LOCATION
FINDINGS: ROLE 110. CMVIE 1TS
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By:
LOT DLAG.WL I
(J.�7 (Z -f 'ocl�y
O
DAVIE COUNTY HEALTH DEPARTMENT
a _ ENVIRONMENTAL HEALTH SECTION
P.O. BOX 57
IT" MOCKSVILLE, N.C. 27028
(704)-634-5985
STATE ENT FOR SEPTIC TA14K IMPROVEMENTS PERMITS AND/O�ITE FWUA��TS
1�1NN 12+��cf ''
NAME` DATE •71 _d"�it''
ADDRESS i" �' �r PERMIT NO.
EXPLANATIO14 OF CHARGE
AMOUNT DUID � SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT OF RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be completed until payment is received.
improvements Permit(s) can not issue until payment is received.
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