134 Powell Road Lot 3�-
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 Date2049
Location
Location _ kna uJ
Subdivision Name W,0400 ar" Lot No. 3 Sec. or Block No.
Lot Size House , ✓� Mobile Home Business Speculation �--^-
R
No. Bedrooms No. Baths ` / No. in Family
Garbage Disposal YES .❑ NO R+ Specifications for System: t'j 00 (Ra * 1LIt
Auto Dish Washer YES NO
Auto Wash Machine YES NO ❑ y
K_
Type Water Supply ���� ",-T4 A _
• n'
*This permit Void if sewage system described below is not installed within 36' months from date of issue.
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l is
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Improvements permit by ' x Ad
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*Contact a representative of the Davie County Health Department for final inspection of this system between. 6.30-
9:30 A.M. or 1:00-1:30 P.M. on day..of completion. Telephone Number: 704,-634-5985.
Final Installation Diagram: System Installedby; ���. F-4 f-
II
ji
Certificate of Completion 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. f.
r, r,
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
NA14E a,,`;�Q �,1 DATE ISSUED l2 ) iP
ADDRESS Z 1S S�ti.s PERMIT NO. :k(yj'i
Explanation of charge�,,.��,. per- �►.� "'� .
AMOUNT
DUE
SANITARIAN
PLEASE REMIT
THE
ABOVE A14OUNT
ON RECEIPT OF THIS STATEMENT.