893 Cana Rd 3 ` /x
'r DAVIE COUNTY HEALTH DEPARTMENT A//
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IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Nof'6-Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name i �'r^r�t� N% .fr Date %� �� 1� �'r �. 2216
Location / tdr. �, ,r! --- �- �"lt r C-- �` i -.j, � � - % s:� .�'•�' ,mss'. �<=,, c.
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Subdivision Name Lot No. Sec. or Block No.
Lot Size Z' � House � Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal , YES p NO p--' Specifications for System:
Auto Dish Washer YES Co NO ❑ � ; J
Auto Wash,Machine YES p NO E] .
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
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Certificate of Completion
�'hR., Date
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*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.
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DAVIE COUNTY HEALTH DEPARThMNT
PERCOLATION TEST RESULTS
DATE e2 /x `7
NAIME
LOCATIO'A
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FIUDINGS: HOLE 140. QCONRiENTS f� /
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LOT DIAGRAM �-
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DAVIE COUNTY HEALTH DEPARTMENT /G•
P. 0. BOX 57
MOCKSVILLE, N . C. 27028 v
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site valuations
NAME �' — ------_ -- - -DATE—ISSUED -- - - - -- -- - -
ADDRESS PERMIT NO.
Explanation of charge
zt&e - - - -
AMOUNT DUE , SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.