951 Farmington 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
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Name _ � � � Date /i°./� �� �,�` �2
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Location �e7/_,_%G';�1� � /�l;' ►�N %c� sem,`/ .''/(�
Subdivision Name_ Lot No. r Sec. or Block No.
Lot.Size " House Mobile Home !�'� Business Speculation
No. Bedrooms No. Baths No. in Family YES
Garbage Disposal P NO Specifications for System:
Auto Dish Washer, YES p NO
Auto Wash Machine:. YES '0 NO p �. (/�/ ��s
Type Water Supply ., . :' _— t. •� ' !" ��•J�% '/'f ��u
*This permit Void if sewage system,desc`ribed below.,is�not installed within 36 months from date of issue.
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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 4)r,\ S
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Certificate of Completion�/ - 1442)6 Date Co/vT�
'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 ottime.
DAVIE COMMIT HEALTH DEPARTMUT
PERCOLATION TEST RESULTS
DATE
NWX
LOCATION �/'�/'
FINDINGS: HOLE N0. COMMENTS
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By:
LOT DIAG.IRA 41,5
s
. DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
14OCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME -114?1,77 DATE ISSUED
ADDRESS PERP-IIT NO. o
Explanation of charg'e'..:,�? t '.�'�: a 9� �✓ ,!�
AMOUNT DUE SANITARIAN
SANITARIAN -��
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.