1553 Underpass Road Lot 9► a 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
Name f Date
Location _
,
Subdivision Name
•
Lot No. i Sec. or Block No.
Lot Size
House
f
`
Mobile Home _ Business _— Speculation
—
No. Bedrooms
No.
Baths _
'-
No. in Family
Garbage Disposal
YES
❑ NO
❑--
Specifications for System:
Auto Dish Washer
YES
0 NO
❑
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
i
Improvements permit by
*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.
r
Final Installation Diagram: System Installed,ti
1
i
r�
i
y
Certificate of Completion t Date f-
*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 /
P. 0. BOX 57 pa -
11OCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME 60• 10 '�Li" DATE ISSUED
ADDRESS 1 AZk, I PERMIT NO.
Explanation of charge tM{�i•- Q� ��:�l.Nc4�,�
AMOUNT DUE O,A SANITARIAN P). Y�1l
PLEASE REMIT THE ABOVE AMOUNT 014 RECEIPT OF THIS STATEMENT.