249 Overlook Drive Lot 5 P/O 4 Section 2DAVIE 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
1 614�
ame A
NDate
Location
Subdivision Name 'Lot No. Sec. or Block No.
Lot Size A-2 House Mobile Home Business Speculation
No. Bedroomsths
No. Ba No. in Family
Garbage Disposal YES 0 NO
Specifications for System:
Auto Dish Washer YES NO
e
Auto Wash Machine YES FL] NO
Type Water Supply
*This permit' Void if sewage system described below is notl�installed within 36 months from date of issue.
'Improvements per
*Contact,a represehtativb`of the ;Davie County Health Department for final i
9:30 A.M. 6? 1,:,00-1:30 -P.M' on,day,
qf completion. Telephone Number,,- 7C
Final Installation Diagram: System Installed
ispection,cif this system between 830-
1-634-5985.
5AV-4
it V I
etion
Certificate of Compl 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
hjhh,satisfactorily for any given period of time.
A
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27023
(7 04) 634-5985
Statement for Septic Tank Improvement Permits
and/or S*te Evaluations
NAME � � /:. { t G,(i �G�/,�", DATE ISSUED
ADDRESS 1�v ✓+ f/l"/%%t' f/��`r r�� PERMIT NO.
Explanation of charge /�%ter"J y-`%`'✓1��
Gov �''•r�
AMOUNT DUE .t'L_ SANITARIAN '! —�ZC�
PLEASE REMIT THE ABOVE A14OUNT ON RECEIPT OF THIS STATEMENT.
1