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515 Sain Rd DAVIE COUNTY .HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 14 Not.Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c. Permit Number Name _�� ' y�,' - Date i/ r- ,; C'0 Location �, r, /.��, v /.R',✓ / �L x".7 - X. Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home — Lam., Business Speculation No. Bedrooms `,� No. Baths Z No. in Family Garbage Disposal YES ❑ NO ❑/ Specifications for System: '%% ' „',, Auto Dish Washer YES ❑ NO ❑-" / Auto Wash Machine YES [] NO ❑ f' -v Type Water Supply _ 'This permit Void if sewage system described below is not installed within 36 months from date of issue. • i i i + r- i 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 r i j Certificate of Completion ' 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. DAVIE COUMT HEALTH DEPARTMENT PERCOLATION TEST RESULTS i DATE 111sD //,v NA:IME LOCATION FINDINGS: HOLE 110. COMMITS lZ 1 P, / ©/ I/ 2 3 UfeAV 4 6 Y,�, J--/ By: LOT DIAGRIU1 p O DAVIE COUNTY HEALTH DEPARTMENT P. 0. BOX 57 HOCKSVILLE, N. C. 27028 (704) 634-5985 Statement for Septic Tank Improvement Permits and/or Site Evaluations NAME �S t� -5%-' DATE ISSUED ADDRESS PERMIT' NO. r • Explanation of charge AMOUNT DUE -S"ANITARIAN PLEASE REMIT THE ABOVE AMOUNT ON '-RECEIPT OF THIS STATEMENT .