224 Keepa Way (3) 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 y',i t] i t -- Date f ! C 2 r 0 Ir
Location
to C"'I t" i'T i'i i
12
Subdivision Name Lot No. Sec. or Block No.
Lot Size ��` House "f Mobile Home — Business Speculation
No. Bedrooms No. Baths L No. in Family
Garbage Disposal YES p NO p Specifications for System: ?C)C)
Auto Dish Washer YES 0NO
Auto Wash Machine YES p NO p .)r? i zr� �S7c:)112
Type Water Supply tr.1 1.it _ t `1"'UAC'1j (C"Clz�t i stri
*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 —sf'�" `,�
*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 Installa ion Diagram: System Installed by t_cr—c
)NAS
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Certificate of Completion `� y �t^-{ 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 'DEPARU4ENT
PERCOLATION TEST RESULTS
DATE
NAME �D �� f-�I t,� 7 2$-7q`I I VW o� "
LOCATION
FINDINGS: HOLE NO. ' fCOM ENTS
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� Y DAVIE COUNTY HEALTH DEPARTMENT C6,
ENVIRONMENTAL HEALT4, SECTION
P. O. BOX 57
MOCS&SVILLE, N.C. 27028-
(704)
7028(704) 634-5985
Statement for Septic Tank Improvements Permits and/or Site Evaluations
IWIViD W Q iD J J I L L DATE
f4cct Gty+stlZu�,77w, G ,,.p �„
ADDRESS�'SO G Hi��7 �V. PER14IT 140.
`
EXPLANATION OFF CHARGE1,
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A14OUNT D oo SAIIITARIAI; �
PLEASE REMIT THE ABOVE AMOUNT 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.