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1631 Yadkin Valley 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 Name Date2r7 2 2 +— LOCatIOn�� t # E/rtt.( i Subdivision Name Lot No. Sec. or Block No. Lot Size t c- 3 House Mobile Home _�' ' Business _— Speculation No. Bedrooms - No. Baths t No. in Family Garbage Disposal YES ❑ NO © Specifications for System: t�� Auto Dish Washer YES ❑ NO p r !i Auto Wash Machine YES p NO ❑ ft, ' -' �/J Type Water Supply "This permit Void if sewage system described below is not installed within 36 months from date of issue. �i .. ............ r 1 i' 1 C� t I 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 by L,L- - E- \V,� Ca�1eQ u,'�c 1�:SS - nn OFF�� CIoScS1 AT 1:..e'0 1 Certificate of Completion S'-\ Date -?D "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. V � � DAVIE COUNTY HEALTH DEPARTMENT PERCOLATION TEST RESULTS pjcfFofz ( DATE �' S LOCATIONC)b 16 YZZ �--- �� =c nJ QA-V" Q4. R-Q. FINDINGS: HOLE NO. COP-RAENTS' T ►o s.�3 '(�2FSor�ic 4. By: 7-7 t LOT DIAGRMl 2 3 DAVIE COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION P.O. BOX 57 / MOCKSVILLE, N.C. 27028 (704) 634-5985 a STATEMENT FOR +SEPTIC TAI4K IMPROVEME11TS PERMITS AND/OR SITE EVALUATIONS NAME DATE COG�;9` 'I ADDRESS PERMIT NO. 2, EXPLANATION OF GE /�yl 1( �q,�;,f �'/�'f'r�✓ r z Al`30UNT t SANITARIAN • PLEASE REMIT THE ABOVE AMOUNT OF RECEIPT OF THIS STATEMENT. *NOTICE: Evaluation(s)- can not be completed until payment is received. ' Improvements Permit can of a issued until payment is receive d.