P2367 Cain Reavis RdDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
°gota:` |oaued in Comp|iance with G.G. of North Carolina Chapter 138--ArUu|e13o.
Name.
Location
Subdivision Name . Lot No
Lot Size House _-__-_-Mobile Home
No. Bedrooms No. Baths No. inFamily
-
Garbage Disposal YES[] NO ��----
Auto Dish Washer YES N<]
Auto Wash Machine YES NO
Type Water Supply
Permit Number
' �����
C..�w {
Goo orBlock No.
Business -__--_---Speculation
Specifications for m:
~ .'
`
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by
,
°Contaucto representative of the Davie County Health Department for final inspection of this oyab*m between 8:30-
9:30 A.M.
:3O'9:3OA.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 7O4'G34'5985.
Final Installation Diagram:
System Installed by
Certificate of Completio,
*The signing of this certificate shall indicate that the 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.
DAVID COUNTY HEALTH DEPARTMEUT
PERCOLATION TEST RESULTS
DATE y -a -9,a
NA'I��
LOCATION -SI 13-2 3 -
FINDINGS: HOLE NO. COMMENTS
1
,_
9�Hy elx� ,�,.�� ����sf 4 z
a
3
LOT DIAGIMMM
it
4
5
0
DAVIE COUNTY HEALTH DEPARTMENT
ENVIRON14EIlTAL HEALTH. SECTION
P.O. BOX 57
MOCKSVILLE, N.C. 27028
(704) 634-5985
STATE114ENT FOR SEPTIC TANK IMPROVEMENTS PERMITS AND/OK"S EVATUA%fO S '
i
NAP4E
,DATE e-
ADDRESS �' PERMIT NO.
EXPLANATOIJ OF CF,ARGE
r
AIMOUNT DUEy w SANITARIAN✓".x
PLEASE REMIT THE ABOVE AMOUNT OF RECEIPT` -OF THIS STATEMENT.
*NOTICE: Evaluation(s) can rot be completed until payment is received.
Improvements Permit(s) can not be issued until payment is received.
b