296 Powell Rd 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
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Name Date
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _= Business __ Speculation
No. Bedrooms — No. Baths —j No. in Family —
Garbage Disposal YES 0 NO E` Specifications for System:
Auto Dish Washer YES 0` NO 0
Auto Wash Machine YES 0NO 0
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 4-7"
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Certificate of Completion -/-" Date -2 —_
*The signing of this certificate shall indicate that the system described above hasj 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 DEPARTIMNT
PERCOLATION TEST RESULTS
DATEOx V why
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LocATloa 61�/7
FINDINGS: HOLE 140. COMMITS
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By:
LOT DIAGM2
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DAVIE COUNTY HEALTH DEPARTi%LENT
P. 0. BOX 57
MOCKSVILLE, N. C. 27028
(704) 634-5985 l
Statement for Septic Tank Improvement Permits
arfd/or Site Evaluations
NAME DATE ISSUED
ADDRESS-& I 394 PERMIT NO. D/ _
Explanation of charge
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AMOUNT D C21) -- SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMEtT.