371 Will Boone Rd (2) 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 /Ur Da N9 2666
Location ?? �. ��%�4�° �`_ ����[��� � z
Subdivision Name Lot No. Seca or Block No.
Lot Size House Mobile Home — usiness Speculation
No. Bedrooms No. Baths f No. in Family
.Garbage Disposal YES ❑ NO S ecificati r ystem:
Auto Dish Washer YES ❑ 21`100�
Auto Wash Machine YES p NO ❑
Type Water Supply _
*This permit Void if sewage system described below is not installed within 36 months from d e of issue.
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
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 for any given period of time. -
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 Date' F
-
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ - ' ....._.__ Business Speculation
No. Bedrooms ti No. Baths No. in Family
Garbage Disposal YES ❑ NO E]
Specifications-for System:
Auto Dish Washer YES E] -NO
p`
Auto Wash Machine YES pf- NO ❑ _
Type Water Supply
"This permit Void if sewage systemdescribedbelow is not installed within 36 months from date of issue. ;
...... ,..:-"'`_----__........_.._._.»..__.._moi
+ 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
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 for any given period of time.
\ �
\
DAVIE COUNTY HEALTH DEPARTMENT
~'
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
Note. Issued in Compliance with G.S. of North Carolina Chapter 130--7Article 13c.
Permit Number
Name
Dat i"10
Location
Subdivision Namd bot No. San or Block No
��
Lot 8ize ~' House Mobile Home -_����-_ 8uaineoo ___------ Speculation ----_-_-_
� `
No. Bedrooms __=�-___ No. Baths __�_���- No. in Fomi|y-___-___
�
Garbage Disposal YES ;E] NO Q,
Specifications.Jor_System:
Auto Dish Washer YES D [?f
�`~-
Auto VVoohK4aohino YES �� NO C]
Typo Water Supply ~ '
*This permit Void if sewage system described bo|ovv is not installed within 30 months from date of issue.
'
-
-``
Improvements permit bv
*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: 7O4'834-5S85.
Final Installation Diagram: System |notsUod by
' .
`
'
CorUfinoba of Completion Date
*The signing of this certificate shall indicate that the system described ubova has been installed in compliance With
the standards set forth in the above vagu|utiun, but shall in NO way be taken as guarantee that the system will function
satisfactorily for any given period of time.
1
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 �� Date ✓�/ "� /� O 2667 .
Location
Subdivision Name Lot No. Seca or Block No.
Lot Size � � House Mobile Home _4f!:!:�Business Speculation
No. Bedrooms c No. Baths No. in Family
Garbage Disposal YES ❑ NO Z' Specifications or Sy em:
Auto Dish Washer YES ❑ O
Auto,Wash Machine YES [
Type Water Supply a4:2
'This permit Void if sewage sy tem described below is not installed within 36 months from date of issue.
J .
���-/1'
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
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 for any given period of time.
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 f'!� - Date
Location —
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 Ej- Specifications for System:
Auto Dish Washer YES ❑ NO
Auto Wash Machine YES 0" ,No ❑
Type Water Supply _—
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by —= w
*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
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 for any given period of time.
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
_ f Permit Number
Date
Name
Location —
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home Business Speculation
No. BedroomsNo. Baths __ No. in Family
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES ❑ NO p r
Auto Wash Machine YES p' NO ❑
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
r
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
1
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 for any given period of time.
DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
- P.O. BOX 57
MOCKSVILLE, N.C. 27028
(704) 634-5985
STATEMENT FOR SEPTIC TA14K IMPROVEMBUTS PERMITS AND/OR SITE EVALUATIONS
NAME - DATE__&Z
ADDRESS JF / PERMIT NOw:'
EXPLANATION OF CHARGE
Ota
a6�Xge
AMOUNT DUI;_�G_" SANITARIAN
PLEASE REI'MIT THE ABOVE AMOUNT OF RECEIPT OF THIS STATEMEIT.
*NOTICE: Evaluation(s) can not be completed until payment is received.
Improvements Permit(s) can not be issued until payment is received.
j