605 Buck Seaford Rd (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' 6"'j'v Date
Location ,` i? L!. r )S 1} {.i "i. f f �,�t L 8 4 / /f r /'i f�V l F•J
Subdivision Name Lot No. Sec. or Block No.
Lot Size f�'"J House Mobile Home — Business Speculation
No. Bedrooms No. Baths No. in Family —
Garbage Disposal YES ❑ NO ❑ Specifications for System: 0100 C'''acti '-A'Ok:-
Auto Dish Washer YES p. NO ❑ :' �` �' ; ! " �; ra c�
Auto Wash Machine YES ❑` NO ❑
Type Water Supply o 0 -T V
*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 --�f
*Contact a representative of the Davie County Health Department for final, inspection of this system between-,8:30-
9:30
etween;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: '' :` b'.;.r System Installed by,— � i�'- !?
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Certificate of Completionr11� LI 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
3 fl�2l
DATE
NAME
LOCATION f Ga tP
P�V£�^f�� L�/`l DS 1 K tJ IJ /,-)/2r /-D
FINDINGS: �' HOLE NO. COM ENTS
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DAVIE COUNTY HEALTH DEPARTMENT �\
ENVIRONMENTAL HEALTH SECTION
P. 0. BOX 57 c)
MOCKSVILLE, N.C. 27028 4
(704) 634-5985 -
Statement for Septic Tank Improvements Permits and/or Site CEvaluations
NAME ��'�n��.�' i (� 17 DATE
ADDRESS_ r j Jli{ ��' PERMIT 1,70. c/
EXPLANATION OF CHARGE S 17 f:•d i1 /wF ' -i'►`t,�3
AI;OUNT DLt ' ; SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON 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.