277 Granada Drive Lot 87DAVIE COUNTY HEALTH DEPARTMENT
` IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
Vte: Issued inv6ompliance with G.S. of North Carolina Chapter 130—Article 13c.
,. Permit Number
Name Date
Location l •. i., r '// i y", r; l r' 1. l i a 3" / C. t; r . / /j
7 7
Subdivision Name
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7
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Lot Size ,, ' : ` '"M f House Mobile Home Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES ❑ NO p-' Specifications for System:;,
Auto Dish Washer YES p NO ❑ 1 r` ,,`a ' �; ,r;
Auto Wash Machine YES [] NO ❑
Type Water Supply _—
r�'
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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.
Final Installation Diagram:
System Installed by
Certificate of Completion '�'Date X�`
*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
MOCKSVILCE,`N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
,%,,�,�'�/V
NAME ,� �w��� DATE ISSUED
ADDRESS., 4X I PERMIT NO.
Explanation of charge
AMOUNT DUE_ SANITARIAN r
PLEASE REMIT THE ABOVE AMOUNT.ON'RECEIPT OF THIS STATEMENT.
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DAVIE: COUNTY HEALTH DEPARTMUT
PERCOLATION TEST RESULTS
DATE
NAME
LOCATION
PIIIDI14GS : HOLE 110. COMMENTS
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