111 Cameron Court Lot EI DAVIE 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
Date 511
Namet��, I JrSel �'�' 2750
�o -� 22i, a ��,
Location
,'Subdivision Name _ �0 Tr e t Lot No. - E Sec. or Block No.
Lot Size" House Mobile Home _ Business Speculation
No. Bedrooms .3 No. Baths °2- No. in Family
Garbage Disposal YES g--".,NO
Specifications for System: l,Z op �Q O • TIN
Auto Dish Washer YES p-''NO 3�r5�c , 2oa`X3�xib
Auto Wash Machine YES g--,;NO
Type Water Supply I vu �v _ S a S
T �� �� �r- .1 ` •►Sa 55e
Y' p� Y ---------
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by • X-" a-
- 11
*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.
' Qr• y
Final Installation Diagram:. System installed by' 1' 1ARTI NJ SVTI c- TAN K—
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
P.O. BOX 57 /
MOCKSVILLE, N.C. 27028 Pdl 7 /,A
(704) 634-5985
STATEMENT FOR SEPTIC TA14K IMPROVEMENTS PERMITS AND/OR SITE EVALUATIONS
NAME�,L1 Se.1 DATE L '�3=
ADDRESS fD4. PERMIT NO. 1.SQ
EXPLANATION OF CHARGE L A E -'i:Mt yam.
AMOUNT DUE 2O.QD SANITARIAN � - N w -A
PLEASE REMIT THE ABOVE AMOUNT OF 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.