2918 Hwy 601N 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' ',' � : :r C i ''7 Date
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size A, House Mobile Home X-- Business __ Speculation
F No. Bedrooms ` �* No. Baths No. in Family C`�
Garbage Disposal YES ❑ NO ❑ Specifications for-System:
Auto Dish Washer YES [] NO ❑ � C .; „r'
Auto Wash Machine YES 4 ' NO ❑
Type Water Supply
*This permit Void if sewage system described 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 %Jes 4-S,- -
m°cC7.�i
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Certificate of Completion Date
Date —
*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 DEPARTtdENT
x P . 0. BOX 57
. MOC:KSVILLE, N. C . 27028
(704) 634-5985`
""statement for Septic Tank Improvement Permits_
and/or Site Evaluations '
NAME � DATE ISSUED
s
ADDRESS PERMIT N0. G �
Explanation ,of " charge 9 'el4aZ 4� .,-� ,
J' ,
AMOUNT DUE G � SANITARIANS
PLEASE REMIT THE ABOVE A14OUNT ON RECEIPT OF THIS STATEMENT �