206 Jamestowne Dr 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
A / l3
Name ���. � /` ! !:,��;�, '.,;�'i-•'f Date `' �' �:� " C9
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size �'� ! /�f� House Mobile Home _business - Speculation
No. Bedrooms No. Baths No. in Family_
Garbage Disposal YES 0 NO p' ��� ��U,
Auto Dish Washer YES p'' NO ,0 Specifications for System: ,.- ,. ,••���, J
Auto Wash Machine YES []'ANO ���-' ��� ✓
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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 ('-� 4"
rim V'�
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 DEPARM ENT
PERCOLATION TEST RESULTS
DATE S; /
LOCATIO.d
PINDINGS: HOLE N0. C0MiMITIS
we
Z
3
3 By: /�zz
LOT DIAGRAM
D
` . a