152 Jetry Ln DAVIE COUNTY HEALTH DEPARTMENT _ -
' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note:;lssued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
NameF Date `)
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size ` r;' House -'� Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES ❑ NO -
,... Specifications for System:
Auto Dish Washer YES E] NO ❑'`
Auto Wash Machine YES [El---'NO ❑ ,�, 1
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 L��' Ca2�► z�'�'
_____�
( �b/y r
•
Certificate of Co,11PIet on _ 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
PERCOLATION TEST RESULTS
DATE '
NA14E
LOCATION
FINDINGS: HOLE NO. COMIENTS
2.
3.
4,
S.
6.
/ �o 1
LOT DIAGRAM (A
Z)
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1
DAVIE CODUTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION (�Q
P.O. BOX 57 /J S �,
MOCKSVILLE, •N.C. 27028
(704) 634-5985
STATEIIE17 FOR SEPTIC .TANK IMPROVEME11TS PERMITS AND/OR SITE EVALUATIONS
f- '� DATE
i
ADDRESS C= 1 ''' :`-• c `� PERMIT NO.
EXPLANATION OF CHARGE ;�;!�' �`� '• - - � a'' ',
AMOUNT SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT OF RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be completed until payment is received.
Improvements Permit(s) can not be issued until payment is received.