142 Powell Road Lot 2Hv
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G S."'of North Carolina Chapter 130—Article 13c.
i, Permit Number
-Name ,.��: . Date »II(J/ 9-P 2050
Location
Subdivision Name LU_SI 4 NOS
b 0 e • Lot No. Sec. or Block No.
Lot Size :1 "�1-� House Mobile Home _ Business Speculation' ---
No. Bedrooms _3__—'No. Baths t No.,in Family
Garbage Disposal YES C] NO 1�1— Specifications for System: �� � �
.Auto Dish Washer YES [�-; NO fl
Auto Wash Machine YES NO �� ��
Type Water SuPPIY IS Ix.3")(: ti
*This permit Void if sewage system described below is not installed within 36`months from date of issue.
�. i
u Improvements permit by,
*Contact a representative of the Davie -County Health Department for final inspection of this system between 8:30- '
9;30 .A.M. or 1:004:30N P M. on _day of completion. Telephone Number:704-634-5985.
Final Installation Diagram:. �! System Installed by e 11,14t
10
Certificate of Completion Date S ! -79
'The signing of this certificate shall indicate -that the system described above has been installed incompliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guaranteeAhat the system will function
satisfactorily for any given period of time.
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
MOCKSVILLE, N. C. 27023
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAMIE `;��,,,,,,,:., Cjkji. DATE ISSUED
ADDRESS PERMIT NO. a --�''a
Explanation of charge s � ,. (AI *i'
Wf,4 atA
Lft—
AMOUNT DUE e,70- G'�'
PLEASE REMIT THE ABOVE AMOUNT
SANITARIAN 9. y`-)n"�_
ON RECEIPT OF THIS STATEMENT.