P2652 Bear Creek Church Rd: DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
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
*The si nin of this certificate shall indicate that the system describe bove has been installed in com liance with
9 9 Y P
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.
Perniit
Number
Name
f
Date
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•
`
1
Location
V
3
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 p NO ❑
Type Water Supply
*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
*The si nin of this certificate shall indicate that the system describe bove has been installed in com liance with
9 9 Y P
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.
r
•
`
1
!
V
3
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
*The si nin of this certificate shall indicate that the system describe bove has been installed in com liance with
9 9 Y P
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.
f -j
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 , Al/ t, ,': r 352
Location��
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms No. Baths f` /`' No. in Family
Garbage Disposal YES p NO [D Specifications for System:
Auto Dish Washer YES Q NO p
Auto Wash Machine YES p NOt�
Type Water Supply __—
`This permit Void if sewage system described below is not installed within 36 months from date of issue.
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.
Final Installation Diagram: System Installed by
I
Certificate of Completions XX 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 COMITY HEALTH DEPARTIMENT
ENVIRONMENTAL HEALTH SECTION
P. 0. BOX 57
MOCKSVILLE, N.C. 27028-
(704)
7028(704) 634-5985
Statement for Septic Tank Improvements Permits and/or Site Evaluations
NAM. C `JG(/jj /J%�t�.�e r DATE
ADDRESS ' / &I PER11IT 140.
'0 ' / .!!%
EXPLANATION or CHARGE
AIM= DUE, .
SANITA
PLEASE REMIT THE ABOVE A14OUNT ON 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.