P2133 Baltimore Rd91
I
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 Sc.>. Date
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ ` Business Speculation
No. Bedrooms No. Baths - No. in Family
Garbage Disposal YES !❑ NO ❑, Specifications for System:
Auto Dish Washer YES ❑ NO ,
Auto Wash Machine YES ❑ NO,[-]
Type Water Supply ,
U '
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
e:�: ,J
'`\ .. -tom'-,_. ♦ ._ i Y� 1
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
D
Certificate of Completion - �)� nmAoDate 5 1.31 11 t
*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.
9
�
c -
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
D
Certificate of Completion - �)� nmAoDate 5 1.31 11 t
*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
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME JleCA-' ocl Co"A7- DATE ISSUED �-01l-7q
ADDRESS ;L PERMIT NO. 3
Qc�vc, +ter
Explanation of charge
AMOUNT DUE ao,c3 SANITARIAN
PLEASE REMIT THE ABOVE `AP40UNT ON RECEIPT OF THIS STATEMENT.