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P2391 Farmington 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. // Permit Number Name r-'. Yf/Z' �'., -1 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 p Specificationso,r,System: Auto Dish Washer YES E] NO © 1 Auto Wash Machine YES ❑ NO] Type Water Supply_— *This permit Void if sewage system described below is not installed within 36 months from.date of issue. f i jG' •�J• it`r t r • ��fl 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 �i .fDate _<- _/' -3M '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. A l DAVIE COUNTY HEALTH DEPARTMENT PERCOLATION TEST RESULTS DATE NAM LOCATION FINDINGS: HOLE NO. C01,24ENTS 2. 4. S. 6. LOT DIAGRAl STATE14EENT FOR SEPTIC ADDRESS EXPLANATION OF CHARGE DAVIE COUNTY HEALTH DEPARTMENT ENVIRONME11TAL HEALTH SECTION Q.O. BOX 57 MOCKSVILLE, N.C. 27028 (704) e' 4A 85 / 16 � �"o r (" (< 1-rlee AND/OR 5ITE EVALUATION5,,1��,� DATE PERMIT NO. IMPROVEMENTS PERMITS AMOUNT DUTL.As--�-6v SANITARIAN PLEASE REMIT THE ABOVE AMOUNT OF 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.