3526 Hwy 158 DAVIE COUNTY HEALTH DEPARTMENT
r 'W IV PROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c. ,
Permit Number
Name _ia ,A 1 t a 1 s << , - Date
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms =' No. Baths t No. in Family
Garbage Disposal YES 1] NO p` Specifications for System: i', 'v&, i„ ►
Auto Dish Washer YES p NO 0-- 1
b, x . 15 , . I ' �. ?• - XI -i-
Auto Wash Machine YES p _ NO Cp
Type Water Supply kLIr 11 _—
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
i
r
i
r
{
1
a
t
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
I
~� It
1
I AH Certificate of Completion ` f Date
*The signing of this certificate shall indicate that the system described abovd 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.
•
Q
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME , y� Qj^moi DATE ISSUED
�
ADDRESS !Rk;Z PERMIT NO. 2��2 3
Explanation of charge
AMOUNT DUE �o•(ft� SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
r