216 Powell Road Lot 1DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT `AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of. North Carolina•,Chapter 130—Article 13c.
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Permit Number
Name b -,e ' Itid ci'r es Date i, - 3o - ,Fo 2586
Location In +! kap 'j1/
Subdivision Name Lot No. Sec. or Block No.
Lot Size House ✓ Mobile Home _ Business Speculation
No. Bedrooms No. Baths 1 �fc. No. in Family
Garbage Disposal YES ❑ NO Specifications for System: 9aa 9c,/A 7',Y -A'
Auto Dish Washer YES NO fl
'Auto Wash Machine YES�s?• ���- �Se'X �'a''�.+I "'�����
p^ NO t]
Type Water Supply �uu I
*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 qk• `l-*�
*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 Installedby.
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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.
DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION V 1� qVv
P. 0. BOX 57 e
MOCK.SVILLE, N.C. 27028
(704) 634-5985
Statement for Septic Tank Improvements Permits and/or Site Evaluations
NMW,-yit rlat;� i t�S k: DATE J a • 3Q -� b
ADDRESS ei J.- °xti: , w�.� S�'1� �. PER1_3IT Ido.
Melt z 7o ? -t'
EXPLANATION OF CHARGE__}}
AMOUNT DUE SANITARIAN *.. y • `C�,il�� V
PLEASE REMIT THE ABOVE IU40UNT ON RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be completed until payment is received.
Improvements Permit(s) can not be issued until payment is received.
DAVIL COMM HEALTH DEPARTDc iT
PERCOLATIOy TEST RESULTS
WESTWOOD SUBDIVISION
DATE 79 NORTH
HIGHWAY 64 WEST
NA:�rE Ju A
LOCATION
MIDIiJGS:
HOLE 110.
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C01 MALTS
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