292 Shady Knoll Ln /..��
x DAVIE COUNTY HEALTH DEPARTMENT
EPARTMENT '
~~
' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name Date J � � �� 2A
�
Location
.\
Subdivision Name Lot No. Soc. or Block No.
'
Lot Size Houoa__-____- Mobile Home -_��� Bueinoeu _-__----- Speculation
No. Bedrooms P- — No. Baths -_1_-__- No. in Fami|y-_-__-__'
Garbage Disposal YES 1E) NO
Specifications for System: Yoo
Auto Dish Washer YES [] NO �]
Auto Wash Machine YES [] NO []
Type Water Supply
*This permit Void if sewage system described below"is not installed within 36 months from date of issue.
Ell
'
`
`
- k
Improvements permit bv
*Contact a representative of the Davie County Health Department for final inspection of this eyub»m between 8:30-
9:30 A.M. or 1:00'1:30 P.M. on day of completion. Telephone Number: 7O4'834'5S85.
Final Installation Diagram: System Installed bv
Certificate of Completion'--:,� Date
^
'
. -
v
*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 vogu|ation, but ehoU in NO way be taken as oguonanb*e that the system will function
satisfactorily for any given period of time.
1
v L
DAVIE COUNTY HEALTH DEPARTMENT
PERCOLATION TEST RESULTS
DATE - a 7-�D
R- . 1 - 8 � 3�s
NAME �`l Si-0.v--Cw Y o cles-
LOCATION 5 • l l 5-3 - \t-o A e_ c- I t F'f i S L�
FIUDINGS: HOLE 210. COMME dTS
s}l- S\\a11t1w AL,ere.i 9'T"'"1
2 - Ill. l Colcn 1f
�� �2 v �2�
20 r"v,. c\ca - 'A Oe
a> �� 3
V� � try-a*+l`S 0.� 36t
�C-4X �.1 S'�r w'E�.�— w.u� 1vcz� -
`M• `cam 5 rv�n� e�u�c� ci'E c9 tea- ��_
By:
LOT DIAGRMAI
,c
2'
DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMEN'T'AL HEALTH SECTION _
P.O. BOX 57
MOCKSVILLE, N.C. 27028
(704) 634-5985 �/ 1
l
STATEMENT FOR SEPTIC TANK IMPROVEMENT'S PEILMITS AND/OR SITE EVALUATIONS
NAPS Sf j: mrn.. DATE
z
ADDRESS ',�.t�;'tom 1 _ a�� 15 PERMIT NO. � 40 2
�� cYst„11�
EXPLANATIOI4 OF CHARGE
,p
A1140UNT DUE 61 U13- SANITARIAN !Z:S, 0^"
PLEASE REMIT THE ABOVE AMOUidT OF RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be completed until payment is received.
Ir,rovements Permit(s) can not be issued until paynent is received.