305 Foster Dairy Rdi
DAVIE COUNTY' HEALTH DEPARTMENT
` IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION� J�
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
/ '//�l Ji''�- �'/ � i.�
Name Date
Location ✓ —
Subdivision Name
Lot Size
Lot No.
Sec. or Block No.
House �= "'J !Mobile Home _ Business Speculation
No. Bedrooms~' No. Baths No. in Family
Garbage Disposal YES ❑ NO p— Specifications, for, System:–' -�
Auto Dish Washer YES ❑ NO ❑ -- ��'`�r J�- �' :ter '' 6
Auto Wash Machine YES E—NO ❑
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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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 z�, • I '
� U
Certificate of Completion
/G f> 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 COUNTY HEALTH DEPARWENT
PERCOLATION TEST RESULTS
DATE
G
NAME
LOCATION
FINDINGS: HOLE NO.
2.
3.
4.
S.
6.
LOT DIAGRA14
By:
DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
P.O. BOX 57
MOCKSVILLE,'N.C. 27028
(704) 634-5985.
STATEMENT FOR SEPTIC TANK IMPROVEMENTS PERMITS AND/OR SITE EVALUATIONS
NAME ���� DATE
ADDRESS "'U> �r�; /%� PERMIT N0.
EXPLANATION OF CHARGE
AMOUNT DUE..;, SANITARIAN �/ Y
PLEASE REMIT THE ABOVE AMOUNT OF RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not ba'complated until payment is received.
Improvements Permits) can not be issued until payment is received.
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