2238 Hwy 801S /G;dp
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 �)i, �;,c-s �r Date �!' °122 +
Location 'r,
Subdivision Name Lot No. Sec. or Block No.
Lot Size House �� Mobile Home _ Business __ Speculation
No. Bedrooms > No. Baths ` ' No. in Family--
Garbage
amily —.Garbage Disposal YES ❑ NO :0 Specifications for System:
Auto Dish Washer YES_p-- NO ❑
Auto Wash Machine YES p' NO ❑
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by
c.'
*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-pp5985.
Final Installation Diagram: System Installed by
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Certificate of Completion �1r1 X11 r .,, �n 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 COUNTY HEALTH DEPARTMENT �•�-�
P. 0. BOX 57 7
MOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAMIE �o�( ( ctwv.c.} R1;.If Q '�e �.; (¢,I�} DATE ISSUED la-�8-79
ADDRESS PER14IT NO. ,2Qoo
Explanation of charge -'S.4c t•,n0. j;j , o, .r p,e
AMOUNT DUE ao•cM SANITARIAN ,_ b
PLEASE REMIT THE ABOVE A140UNT ON RECEIPT OF THIS STATEMENT.
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DAVIE COUI3TY HEALTH DEPARTMENT Pu,t �e/<✓.
PERCOLATION TEST RESULTS JoE /Y)AnJJ- ec.cle
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DATE
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FINDINGS: HOLE 140. COMMITS
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