179 Fulton Rd (2) 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 Date �/ ` �� P. .
r ,
Location ( `/ :/ 7 /„y;, f/i i. ;i� /;/, ��- i.�%' ;J,
Subdivision Name Lot No. _ Sec. or Block No.
Lot Size CtL- ^- House Mobile Home _k Business Speculation
No. Bedrooms 3 No. Baths 2 No. in Family
Garbage Disposal YES 0 NO ❑ Specifications for System:
Auto Dish Washer -YES ❑ N0 ❑ ;��. '.�_ ,�,� '�� /`'ter��
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.
79-
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 LI,n„
Certificate of Completion Dater)' -72
*The signing of this certificate shall indicate that the system described above has been installed in'1 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.
Rf ti
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57 �
HOCKSVILLE, N. C. 27028
(704) 634-5985 _
Statement for Septic Tank, Improvement Permits
a`nd/or� Site Evaluations
NAME DATE ISSUED
ADDRESS PERMIT ,NO .
Explanation of charge
AMOUNT DUE �2,D-4 SANITARIAN
PLEASE REMIT THE ABOVE;.A11OUNT ON RECEIPT OF THIS STATEMENT .
DAVIE COUNTY HEALTH DEPARTMEWT
PERCOLATION TEST RESULTS
DATE —//— 7F
MIX CLL Ali&
LOCATION oZ r' h vu rt ar, �t —S� /�/Z — d. ,�v? �!•l��_
FINDINGS: HOLE NO. COMMENTS
/a"/a-Z-2- 6- 9-�9
3
5
6 ( ACV
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BY: cs-
LOT DIAGRAM
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S
ti
ail (1�>a»xt# ttY#1� Pry rimmf
P. O. BOX 57
�1kTvcks�iille, �>�rtjj. flltsrpliatt 27Q2:i .
OFFICE OF THE DIRECTOR TELEPHONE
June 119 1979 704/634.5985
I'7r. Charlie. Richie
Route ? '
"M66V's vi1169' N.C, . 27Q2Q <
Soil/SiteEvaluation� SR. No. 1612
Re: .., ,
q. Mr` Richie.
On June '111' 1979 your property listed above was evaluated by this. office:.
tD":'determine the soil suitability for a septic tank system._ As a result of
thst evaluation your property has been classified as. suitahle. In order to
design.a sewage -system that would function properly I need .the following 1
information• x.
1. Is your mobile home, goiri to he placed in front of the shec}f ,
2. What type of water supply will you ush
test avail
3. Is the.area in front of the
perk test to us
for:tho septic tank,
Please let us know all the above-_as. we have started your permit but
are unable to complete it until this information is provided. Also' please
find enclosed a statement for the amount due. As :soon as we receive the
pay.ment `.and th.e information requested,-we. forward the permit to you at
pnce.b
Sincerely,
Mando' Snn. Superv5 am
Davie County. Heplt:h f)nprirtmeni: