180 Powell Road Lot 6DAVIE; COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION.
*Note: Issued in Compliance with G3of,,. Carolina Chapter 130—Article 13c.
Permit Number
Names R,1 Date />�' 204
Location.. lo
t.cr
Subdivision Name U&:i7�A411 Lot No. Sec. or Block No..
Lot Size. /yo X.2 ay House !i- Mobile Home _ Business _ Speculation
No: Bedrooms_ No. Baths / No. in Family
Garbage Disposal YES p NO -[-
Specifications for System: qaa qa/
Auto Dish Washer .,YES 2- NO, d
AutoWash Machine YES [y"• NO E1
Ty7-5
pe . Water Supply _
*This permit Void if sewage system; described below isnot installed within 36 months from date of issue.
y -
. 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 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by
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
NAPfE �cw ��� DATE ISSUED ♦���J 7r
ADDRESS �/S ��' _ �i/• PERMIT NO.
/11
Explanation of charge
AMOUNT DUE'0 cr. `j
PLEASE REMIT THE ABOVE AMOUNT
SANITARIAN- ,^i'7
ON RECEIPT OF THIS STATEMENT.