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214 Vineyard Ln (2) i ffb o 4 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 Name N o Date Lo tion 1l - s�� A-S Y �v l-c.� ti._ .,� C r e¢(� c�� ,c� '5-k—p.c / Ct-r-V — w!✓ J L. l^ /lam r R-A Q r J 11�SCJ C1�wLA/ c/1 LJQ Of�FZ`s 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 ❑ NO 5�-- Specifications for System: Auto Dish Washer YES ❑ NO R- Auto Wash Machine YES Q--NO -❑ 7 rT' V--j - I-3 1 3'70/ Type Water Supplyt "This permit Void if sewage system described below is not installed within 36 months from date of issue. , may \�ou5c� 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. Final Installation Diagram: System Installed byV'4j'L Oluj z te' �. E ~ "w Certificate of Completion-5 ' 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 for any given period of time. DAVIE COUNTY HEALTH DEPARTMENT PERCOLATION TEST RESULTS �.t DATE � -� � ' "T613� NAME /UGf�i:sN S►m: /� Q��1 l kil Al•t• _ � 27os[s_ LOCATION ln;l :nr vS% /I 1.4f Ar, <r4t /�1` • �1 `61,0 k w• 0. FINDINGS: HOLE NO. C01-24ENTS 1• Clo, told'- 2. :�bsa' 1.• Qc�:c1 �.a.•tt ',. �v,c 3. c�.+.144�s - Y`a e.a.Jc, `t' �•af�l�= arQ.C� 4. taprat,�c..- �. 5. 6. 1� vy By: LOT DIAGRA14 f l DAVIE COUNTY HEALTH DEPARTMENT 4, 4 ENVIRONMENTAL HEALTH SECTION • P.O. BOX 57 MOCKSVILLE, N.C. 27028 (704) 634-5985 �- 4 STATEI2I1T FOR SEPTIC TANK IMPROVEMENTS PERMITS AND/OR SITE EVALUATIONS NAMEI V ��i C 4� Svc �� DATE S`-b- ADDRESS N; u��s �,(, 'Le`r 6 ` t� (os(o} PERMIT NO. J?p 3 ura� ga-k-p VEL a 70%jT EXPLANATION OF CHARGE S�. �1�. 4-",.4— AMOUNT -",.4AMOUNT DUE; rao•V\) SANITARIAN_4_:—Q'. �. Y � PLEASE REMIT THE ABOVE AMOUNT OF RECEIPT OF THIS STATEIMiT. *NOTICE: Evaluation(s) can not be completed until payment is received. Improvements Permit(s) can not be issued until payment is received.