168 Powell Road Lot 8DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance.•with G.S.of North Carolina Chapter 139 --Article 13c.,
s_ Permit Number
Name �R v: e ��s . 9 I Date /°��/ y, Ze 2044
Location
Subdivision Name j0?e 1,6&0 Dd . ;k,'V.S�
Lot No, Sec. or Block No:
Lot Size Housey'' Mobile Home _ Business Speculation
No. Bedrooms 3 No.. Baths _ No. in Family
Garbage Disposal- YES ❑ NO p'
. Specifications for System: ?,60 90.0 7"4H14 _
Auto Dish Washer YES , NO 0 -
�:si: r3�
Auto Wash Machine YES .p NO El
Type Water Supply wuy"11"I', E!%
This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by
*Contact a representative- of the''Davie County Health Department for final inspection of -this system -between 8-'80--
9:30 A.M. or 1.:00-1:30 P.M. on day of,,completion.'Telephone Number: 704-634-5985.
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
MOCKSVILLE, N. C. 27028
(7 04) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME DATE ISSUED W,11511,90'
0
ADDRESS /� j.�• PERMIT NO.
Explanation of charge-44-10ti✓
AMOUNT DUE- 41 "'Z)
PLEASE REMIT THE ABOVE AMOUNT
SANITARIAN t /'1' ,,4i
41z"
ON RECEIPT OF THIS STATEMENT.