P2361 WoodleeDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION jJ
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name ir� �� .�L �` Date--5�",�;; r}' 2?61.
�t ✓IK1� / ice' f� �!. t� C { " < moi, : - ( . /''/ ` �l
Location
Subdivision Name Lot No. Sec: or Block No.
Lot. Size f .1 fx House Mobile Home _"'rBusiness '` + Speculation
No. Bedrooms No. Baths No. in Family /
Garbage Disposal YES ;ENO p-!�
� Specifications for System .
Auto Dish Washer. YES -
pj: NO
Auto Wash Machine YES 0 NO 0 ..
Type Water Supply,7r.��.,�,j
*This permit'Void if sewage system described below is not installed within 36 months from date of issue.
Improvme is permit
• n
*Contact a representative of the Davie County Health Department for final inspection of this system betu
9:30 A. M. or 1:00-.1:30 P.M. on day of completion. Telephone Number: 704=634-5985. it ,
8:30-
DAVIE COUNTY HEALTH DEPARTMUT
PERCOLATION TEST RESULTS
LOCATIOl
FIUDItNGS : HOLE 110. COMMENTS /
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By: /
DAVIE COUNTY HEALTH DEPARTMENT
EWIR0IT14MITAL HEALTH SECTION
P.O. BOX 57
MOCKSVILLE, N.C. 27028 ll
(704) 634-5985
STATEMENT FOR SEPTIC TANK.111PROWMUTS PERMITS AND/OR SITE EVALUATIONS
NAME DATE
PERMIT NO.
ADDRESS j
EXPLANATION OF CHARGE
WIOUNT DUE SANITARIAN
PLEASE RE14IT THE ABOVE AMOMNT OF RECEIPT OF THIS STATEMENT.,
*NOTICE: Evaluation(s) can not be completed until payment is received.
Irm,rovements Permit(s) can not be issued until payment is received.