688 Howardtown Circle DAVIE COUNTY HEALTH DEPARTMENT 3�
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*,1`461b: lssued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number.
Name '/1!17;/2 /?c r !-a otJ Date Sy n
�� 92
Location ,js 1 Ca j� r'itli,1IJI-lt1 /T-l.) �; t" /f,tCZ5� oC\j
Subdivision Name Lot No. Sec. or Block No.
Lot Size 7- _ House �-� Mobile Home _ Business Speculation
No. Bedrooms 1-7 No. Baths �°r No. in Family
Garbage Disposal YES ❑ NO [+l Specifications for System:
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.
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 'Bet,, (n,-*S
tr' �"'s
I
i
Certificate of Completion S-\ `'l',no„ n Date 12-
'The
2*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 DEPART?,MNT
PERCOLATION TEST RESULTS
DATE
NM4E CA1ZTtfZ- 114
LOCATION /400172 -bWtJ 1C
FINDINGS: HOLE NO. COMIENTS
4.
S.
6.
By: 5fi44-5
Ti6t-,rT
LOT DIAGRM
f�/�-�2cY" Gc�v�� -S77Z4E�v2F.
3 i
z �
DAVIE COUNTY HMTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
P.O. B6X 57
MOCKSVILLE, N.C. 27028
(704) 634-5985
STATEIWNT FOR SEPTIC TANK IMPROVEMENTS PERMITS AND/OR SITE EVALUATIONS
/ ` 0
NAPS Ct'�2T �"" IO >zTsd N/ DATE '
ADDRESS • IJ / PERMIT NO. 3 ( Z
6vA1Nc5-7 NG 27aa�
EXPLANATION OF CHARGE / 5/TE f 41.4ty4r!o I h'it'.
°d P�"4 5
AMOUNT DUE }� ' SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT OF RECEIPT OF THIS STATEMEIIT.
*NOTICE: Evaluation(s) can not be completed until payment is received.
Improvemants Permit(s) can not be issued until payment is received.