748 County Line Rd �~~ � DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION --
°Note: Issued in Compliance with G.G. of North Carolina Chapter 130—Article 13c.
Permit Number
Name Date
Location
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Subdivision Name Lot No. Seo. or Block No.
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Lot Size ` House -___-_-_ Mobile Homo Business _-__-_-_ Speculation
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No. Bedrooms __��--__ No. Baths -_�_��_-' No. in Fami|y_-----_-_
Garbage Disposal YES Ej NO F] Specifications for System:
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Auto Dish Washer YES [j NO 0
Auto Wash Machine YES F-� NO F
Type Water Supply ,
*This permit Void if sewage ayobam doonhbod below is not installed within 36 months from date of issue.
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- Improvements permit by
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*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: 704-884'5085.
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Final System Installed
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Certificate of Completion Date
*The signing of this certificate shall indicate that the system described above has been installed in oomp|ionce with
the standards set forth in the above nagu|adion, but shall in NO way be taken as uguarantee that the ayab*m will function
satisfactorily for any given period oftime.
DAVIE COUNTY HEALTH DEPARTMENT
P . 0. BOX 57
MOCKSVILLE , N. C . 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAPE � DATE ISSUED
ADDRESS �,,�'� \ PERMIT NO . ' t
Explanation of charge
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AMIOUNT DUEVit,. �s SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.