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536 Davie Academy Rd ytyr � ,r: Aja g,�;Ir`•+ �'', i 'x ,`. I i �r t4 `i f� � I�•R/%i DAVIE COUNTY HEALTH DEPARTMENT ZA }k IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION > r *Note Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c. I'PermR Number Name ,�✓r�troi/. r''.� i �`� Date /� / r�'� .. `> ��i C Por ' )Location f jr f %l { � f'"je' '✓'f'(.' /�•.-.�`%/r /. %� �'�� , f'�� ,:.,.. •,.i"�'�-^':� � Irl '� 5 {.✓f rC Subdivision Name Lot No. Sec. or Block No. G tot Size ' •'! House Mobile Home Business Speculation J. r�'`a ✓' No Bedroomst, No. Baths No. in Family �- q i• v4 '` Garbage Disposal YES p NO p� r { Specifications for . -y t, Auto Dish Washer YES © NO p � Auto Wash Machine YES ® NO p r ;Type. Water Supply ;., `This permit Void if sewage system de's ribed below is not installed within 36 months from date of issue. ' c i ------�- 1 1 y 1 f Improvements permit by } ) � f *Contact a representative of the Davie County Health Department for final inspection of'thIS system * ` 9.30 'A.M. or 1:00-1:30 P.M. on day of completion. T lephone Number: 704-634=5985 F 1� Final Installation Diagram: ✓��' ystem Installed by ✓tel/ t tr Pt CI j i. EL i 1 Certificate of Completion Date "TheJsigning'of this certificate shall indicate that the system described above has been installed in compliance with" t the standards set forth in the above regulation, but shall in NO way be taken as a guarantee'that the system will function.„ y satisfactorily for any given period of time. r r u. DAVIE COUNTY HEALTH DEPARTMENT T TIO 5 PERCOLATION TEST RESULTS II' II � DATE �. NAr4E � S LOCATION (/ CAl�14' u r FINDINGS: HOLE N0. CO IIENTS 4. OW 2. S S /,•� 6. By: r t i LOT DIAGRAti i i DAVIE COUNTY HEALTH DEPARTMENT ENVIROIMNTAL HEALTH SECTION P. 0. BOX 57 MOCKSVILLE, N.C. 27028- (704) 7028(704) 634-5985 Statement for Septic Tank mprovements Permits and/or Site7;;,7 ns r NAME DATE ADDRESS PERMIT N0. EXPLANATION OF CHARGE AMOUNT Durls2—f SA14ITARIAN � PLEASEREMITTHE 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.