131 Gunter Ln 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
Namei �. ,i Date
Location C o ra - _j + C' `;,t•„ 4 w- ='�i - l l� tP „a1:,t
—
Subdivision Name Lot No. Sec. or Block No.
Lot Size 'i < < House Mobile Home '''� Business Speculation
No. Bedrooms No. Baths No. in Family 2
Garbage Disposal YES ❑ NO p- Specifications for System: oo Ott tea Tr„�k`
Auto Dish Washer YES ❑ NO fl°'
Auto Wash Machine YES d� NO ❑ -6- ,-77
{ - x �'t
Type Water Supply t_*s t- I t -_—
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
r�
C
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 �' rn 1-+ ohs
1�
Certificate of Completion i1 Date
*The signing of this certificate shall indicate that the system described %hove 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
DATE J/-
NAME je p (��,.,,TE�2 ' '3`x'a7.z - 8
/fio�/esu://c.�sv•r Z�v zP'
LOCATION l a/N - �r,� !�G/ �,. C%n Q«R" -�•c �1 �',��sS
/' � - /�`-Lvlr/ L�.•nI9 v .� Lit j v- T•le F-} -
FINDINGS: HOLE NO. CO1•2IENTS �wt�
1.
1JCvM +�i
2.
3. 2clyM;,. pick V: .4.
�(� ..•a-3�� s
Q S4�c0
s�ee`� 5. 3y rn•., /,ncL �+ uua',�. _ �2� "�c&1c .
6.
LOT DIAGRAI.1
-//-p 17,,:30
DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
P.O. BOX 57
MOCKSVILLE, N.C. 27028
(704) 634-5985
STATEMENT FOR SEPTIC TAIJK IMPROVEMENTS PERMITS AND/OR SITE EVALUATIONS
NAME `Tr r.ti,.�t (�a _,1 L DATE '/.. ?' /
ADDRESS 'ar. v. j' �?I a. - ti PERMIT NO. R G
qac t.
EXPLANATION OF CHARGE ,'...,r;,:;�,+'r,,,
AMUNT DUE 14•c-� SANITARIAN I dA-A
PLEASE REMIT THE ABOVE AMOUNT OF RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be completed until payment is received.
Irmrovements Permit(s) can not be issued until payment is received.