P2271 Becktown Rd�
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: |auund in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Name 4 enll Dat 2
Location
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Permit Number
'
Subdivision Name Lot No. Sec. or Block No.
u�-----`
Lot Size House Mobile Hm�____ Business____ Speculation
No. Bedrooms No. Baths __�Nn.inFamily
_____-__
Garbage Disposal YES -E] NO E] --
Specifications 'for System:
Auto Dish Washer YES N{}
Auto Wash Machine
Type VVa1or Supply
*This permit Void if sewage system described below is.not installed vv|1Nn 36 months from date of issue.
Improvements permit bv
°Contactn representative of the Davie County Health Departkent for final inspection of this uyob*m between 8:30-
9:30 A.M.
:3O'Q:3UA.M. or 1:00'1:30 P.M. on day of comp|edion�Te|epkobeNumber: 7U4 -G34'5985.
Final Installation Diagram: Syst rn Installed by 2.a� !;Z� I
st
3�v
X3
Certificate of Completion�L—�
*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 oftime. ,
-lmell
DAVIE COUNTY HEALTH DEPARTMENT
PERCOLATION TEST RESULTS
DATE
LOCATION
FINDINGS: HOLE 110.
LOT DIAGRWI
6
2
6 -3-
By -
CO: MMITS