275 Davie Academy Rd /'. o)
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note:::lssued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name Date %�.'7/�J �*�
('...�,4.7 S
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size 4 `'' House Mobile Home — Business Speculation
No. Bedrooms 3 No. Baths a No. in Family 4
Garbage Disposal YES ❑ NO E--
Specifications for System:
Auto Dish Washer YES p-' NO ❑ ,,.A_ r-:4 _ --� I .-)"/ 3- ;-
Auto Wash Machine YES p' NO ❑
C. it
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
vrl'
r
- - — ,
c
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 byu�� 57r°iP
00
Certificate of Completion Tri` Date `J V
*The signing of this certificate shall indicate that the system describ9d 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 DEPARTMENT
P . 0. BOX 57
MOCKSVILLE, N. C . 27028
0-
(704) 634-5985 '71 27/n h�
Statement for Septic Tank Improvement Permits U
and/or Site Evaluations
NA11E � i ('„ DATE ISSUED
ADDRESS PERMIT NO . G Z
Explanation of charge 1
��w r
AMOUNT DUE .,?a, SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
DAVIE COMITY HEALTH DEPARTMiT
PERCOLATION TEST RESULTS
DATE-- 71')717Y
NA.n'lE �fl�l f'�A earyo.._
LOCATION 9,ee&hX,//" %d S7�d�7 $ h - �PdPti�4 )n ("unuE o+. �►hv�t Ac� �Pua�
FIMINGS: HOLE NO. COM ENTS o
Vz-4 41Cl/J
plf.17"C- S6
2 Qf S,05,j_4,
/lo Z-P;41--.cc d/2
3 qac
4
3
6
BY:
LOT DIAGLW4
i
p b
� o'
4 35
V/ •'� `
) O O
l
i