194 Powell Road Lot 4DAVIE 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�►Ji���Iciens Date .1z-3a.go
Location 6 t)
Subdivision Name t �es1-tel o "�' D� Lot No. Li Sec. or Block No.
Lot Size
House
L—�' Mobile Home.
No. Bedrooms 3
No. Baths J VZ No. in Family _
Garbage Disposal
YES ❑ NO
Auto Dish Washer
YES [ NO
❑
Auto Wash Machine
YES y NO
❑
Type Water Supply_—
Business __ Speculation
Specifications for System: 7.0
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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Improvements permit by
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*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 N mber: 704-634-5985.
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Final Installation Diagram: Systej Installed by .
Certificate of Completion Date :,
2a�
*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.
DAVIE COUNTY HEALTH DEPARTYX14T �
ENVIRONMENTAL HEALTH SECTION
P. 0. BOX 57
MOC&SVILLE, N.C. 27028
(704) 634-5985
Statement for Septic Tank Improvements Permits and/or Site Evaluations
Y7AbIE iAV ! E 3�J�i 1�1� S DATE a -3d ^ k V
ADDRESS Z 1S' CwV-%L S('• PERMIT NO. AST f
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EXPLANATION OF CHARGE 5•� .lug (,����w P+"4
AMOUNT DUE , 0 SANITARIAN
PLEASE REMIT THE ABOVE A14OUNT ON RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be completed until paynent is received.
Improvements Permits) can not be issued until payment is received.
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DAVID COMITY HEALTH DEPARTMiT
PERCOLATION TEST RESULTS
DATE
LOCATIOid
FINDINGS: HOLE 140.
1 1" 36 601'A i,
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WESTWOOD SUBDIVISION
NORTH
HIGHWAY 64 WEST
CO:I ITS
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By: 1111dng ��%�
LOT DIAGRMI
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