303 Fantasia Ln (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
Name Date
Location �;` / - ' - z ;
Subdivision Name Lot No. Sec. or Block No.
Lot Size (,Housp., Mobile Home Business -- Speculation
No. Bedrooms No. Baths _-_ No. in Family
Garbage Disposal YES ❑ NO O Specifications for.SystemL-
Auto Dish Washer YES E]-'-NO ❑ -
Auto Wash Machine YES O' 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
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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: 704-634-5985.
Final Installation Diagram: System Installed by
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Certificate of Completion i/ —.t ro Date -i
*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 DEPARTMENT
P. 0. BOX 57 �v _[
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
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, NAME ,!!t;'jet ;''` /1 lr DATE ISSUED 11L 7
-ADDRESS�,'�'A �. ''- PERMIT NO.
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Explanation of charge ,l � v�f..ty 'y - f•— �
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AMOUNT DUE SANITARIAN / Cx
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMEN .
DAVIE COUNTY HEALTH DEPARTZ,1EIdT
Perc is for
PERCOLATION TEST RESULTS 3—bed daub—wide
mobile home
DATE
George Barnes 9984558 Address: Route 39 Advance, NC 27006
Off Peebles Creek Road, turn right at the church and go down
LOCATION about a mile and go down road(farm road) by first two story house.
FINDINGS: HOLE 140. C0111 TENTS
1 Well os already down
to depth of 310feet.
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By:
LOT DIAGR1I