1168 Junction 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 } �� .�.. C` :,t a'}.��, Date LL - -"'1 f 2
Location
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Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms `} No. Baths 2 �� No. in Family
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Machine YES ❑ NO C]
Type Water Supply
`This permit Void if sewage system described below is not installed within 36 months from date of issue.
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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 Nmber-704-634-5985.
Final Installation Diagram: System Installed byc *", ((-r,
Certificate of Completion S7N-- ���a,. r > 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 z— /,3 - ��
97
NAME {�l7tinr �jrC-.�r�d it/ IOC�Pt�,l�t� N•�.
LOCATION Z--l)Vv.t7, 2, J-
FINDINGS: HOLE NO. COPIENTS
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LOT DIAGRAM / !
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. DAVIE COUtdTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
P. O. BOX 57
MOCRSVILLE, N.C. 27028
(704) 634-5985
Statement for Septic Tank Improvements Permits and/or Site Evaluations
IiAbIE �,,Ct „ . . DATE �.,13 4-
ADDRESS � `� 7 PER14IT 140. AIS c�USF1
EXPLANATION OF CHARGE
AMOUNT DUE O'RI SANITARIAN . YI-N"
PLEASE REMIT THE ABOVE A140UNT ON RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be completed until paynent is received.
Improvements Permit(s) can not be issued until payment is received.