202 Powell Road Lot 3DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS"PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with; G.S. of North Carolina Chapter,130�, Article 13c.` t s{f
ii Permit Number
Dat
Name i�v',F: 8,;,tc�;As e i� -30 -Y �, r`� t;: 88
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Location
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�Subdivision.Name«Z w off"���-
Lot No. Sec. or Block No.
Lot Size 11Fod2ue House II Mobile Home _ Business Speculation
No. Bedrooms No. Baths tH'No. in Family
Garbage Disposal YES C] :NOK
p
Auto Dish Washer YES " Specifications for System: 9 � gu l w �u~
Auto Wash Machine YES NO
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
I!
jImprovements permit by
I
*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
i)
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.
111VIL COMITY HEALTH DEPARTMiT
PERCOLATI024 TEST RESULTS
/ WESTWOOD SUBDIVISION
DATE "� _ / �' � �
NORTH
HIGHWAY 64 WEST
NAME �! � �`� n �� UWco��._.
LOCATION }� �.,.. L, 4 W t
FIIIDI14GS : HOLE 130.
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COMMITS
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DAVIE COUNTY HEALTH DEPART^TENT
+, ENVIRONMENTAL HEALTH SECTION
P. 0. BOX 57
MOCKSVILLE, N.C. 27028
(704) 634-5985
Statement for Septic Tank Improvements Permits and/or Site Evaluations
NAME "� RyiE ►;.\c�t� 1 DATE W -So -W
ADDRESS .. IS PERMIT 140. as P'Y
�Y.
EXPLANATION OF CHARGE
AMOUNT DUE _ 2 - Utb
SA14ITARIA14 Cj . YV�r•.�.Q.,
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be completed until paynent is received.
Improvements Permit(s) can not be issued until payment is received.