175 Willmat 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
Name Date 0
Location :F. - ,:i. ✓ �' t '
Subdivision Name Lot No. Sec. or Block No.
Lot Size -L"'� .- ., " House Mobile Home _ r` Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES ❑ NO [D--- Specifications for System:
Auto Dish Washer YES p NO ❑
Auto Wash Machine YES �]^ NO ❑
Type Water Supply
-1-D 7-.00 Y 3 K Z�
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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1
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
01 ,
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.
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DAVIE COUNTY HEALTH DEPARTMENT
PERCOLATION TEST RESULTS
DATES
v./l
NAIAE
LOCATIONi� �� //f/
FINDINGS: HOLE NO. C01,24ENTS
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4.
110
S.
6.
By:
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LOT DIAGRM-1 6
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DAVIE COU.TY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
P.O. BOX 57
MOCKSVILLE, N.C. 27028. \
... (704) 634-5985,-}
STATEMEIrr FOR SEPTIC TANKJ'IMP OVEMENTS PERMITS AND/OR SITE EVAL ATIONS
DATE-
ADDRESS
--� PERMIT N0.
EXPLANATIO24 OF CHARGE --24 �i'L'�` . .t"-�?•�j r/.�`• :%%:Vii/
AMOUNT DUE., of • SANITARIAN,.-
PLEASE
ANITARIAN .-
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.