152 Station Ln (2) DAVIE COUNTY HEALTH DEPARTMENT Y! o
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
/ - Permit Number
Name (r ;.�,�1f�'�--. <lr�; Date �,' 'Vii'! i ? `: ���C�
Location /i/,:n:✓ '�t'� i i �Y'�� % i ,f�y ✓r% / %' ��V
Subdivision Name Lot No. Sec. or Block No.
Lot Size > House Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES ❑ NO (p Specifications for System:
Auto Dish Washer YES ❑ NO .0
Auto Wash Machine YES ❑ NO ] �C Y�
Type Water Supply �';r�r/•/' __ �`cT :� ,';r'.i:"" :!.�'
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
), �� .':i'i,'�j✓ ;iii% C --�� ;%� r
A �
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
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Certificate of Completion Date e
"The signing of this certificate shall indicate that the system described above has been installed in complianc
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will
satisfactorily for any given period of time:
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DAVIE COUNTY HEALTH DEPARTMENT �Q
P. 0. BOX 57
HOCKSVILLE, N. C. 27028 I
(704) 634-5985 ; ( 6
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAMEDATE ISSUED
ADDRESS PERMIT NO.
Explanation of charge ��/f��'Li�x� ,4, i�-�;z.• _
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AMOUNT DU SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
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DAY IE COUNTY HEALTH DEPARTMENT
P: 0. - BOX' 57
_ '�• r s ,.
HOC KSVILL E, N. C. 27,028
(704) . 634-5985``
'Statement for Septic .Tank Improvement. Permits j
and'/or. Site: Evaluations
NAME DATE ..IS
.�.
ADDRESS ►!. PERMIT N0.•
�
Explanations of charge
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AMOUNT DU SANITARIAN< fl tet-
PLEASE ,-REMIT THE .ABOVE 'AHOUNT ON RECEIPT: OF ,THIS. STATEMENT y"
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