208 Powell Road Lot 2DAVIE COUNTY_.HEALTH DEPARTMENT
IMPROVEMENTS 11PERMIT AND CERTIFICATE OF COMPLETION
`Note: Issued in Compliance with G.S. of North Carolina Chapter'130—Article 130.
h umber Permit :N
2587
Name. f�v'� F '�. ,1� i, r . Date 1�. - 30 -�11 �;`� �1,
to ��ri�S � P.'
Location W li
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Subdivision Namet,Nu���. Lot No. Sec. or Block No
Lot Size -(m Wt House i Mobile Home _ Business Speculation
No. Bedrooms No. Baths ��' No. in Family
Garbage Disposal YES C NO e----
Specifications for System: gt3p SQ jIU..TQ ,,k
Auto Dish Washer YES NO fl s
�
Auto Wash Machine YES NO �'�� Z -i ISO,X `t.
Type Water Supply PtnA Z
This permit Void if sewage system described below is not installed within 36 months from date of issue.
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11, �A
Improvements permit by
'*Contact a.:representative of the Davie County Health Department for final inspection of this system between 8:30-
9:30 KM. or .1:00-1:30 -P.M. on day. of cornipletion. Te lephone_Number. 704-634-5985.
f'• f r
Final Installation Diagram: �I ste Installed by `� t
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 timer
DMUL' COMMIT HEALTH DEPARTIENT
PERCOLATION TEST RESULTS
DATE ,511 S// 7 9
LOCATION to itij,- . (e u \._)/c:V
FINDINGS: HOLE 140.
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WESTWOOD SUBDIVISION
NORTH
64 WEST
CO: ME TS J
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DAVIE COMITY HEALTH DEPAR=NT
ENVIRONMENTAL HEALTH SECTION
P. 0. BOX 57
MOCKSVILLE, N.C. 27028
(704) 634-5985
Statement for Septic Tank Improvements Permits and/or Site Evaluations
NAbIE -10,,, . V �?'�a .1 J t, % DATE i --, -3o - Fy
ADDRESSRIS- 15 �ci�: S�r�. S'�" PERP4IT 140.
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EXPLANATION OF CHARGE T. l cti. ,.'�- "I e ZMw d ;414+ -. I j
AMOUNT DUEjQ.dD SANITARIAN '� L
PLEASE REMIT THE ABOVE A110UNT ON RECEIPT OF THIS STATE14ENT.
*NOTICE: Evaluation(s) can not be completed until paynent is received.
Improvements Permit(s) can not be issued until payment is received.