530 Frank Short RdDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of NorthrCarol ina Chapter 130—Article 13c.
r; Permit Number
Name ft i'(¢ <_i t*J Date JZ7,�i.
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Location _
Subdivision Name Lot No. Sec. or Block No.
Lot Size f �' House Mobile Home _ }4 . Business Speculation
No. Bedrooms '� No. Baths � No. in Family
-Garbage Disposal YES ❑ NO Q,ji
Specifications for System:
Auto Dish Washer YES ❑ NO ❑12
'
Auto Wash Machine YES E] NO F-19
Type Water Supply 1' J
*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
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ICertificate of Completion // �'� s Date 7 4 7- , /�
'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 DEPAMENT
PERCOLATION TEST RESULTS
DATE -7-
NPM
7NAPE �kCPff
LOCATION
FINDINGS: HOLE NO.
2 - °S
2.W
4.
5.
6.
LOT DIAGRAM
COMIENTS
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C. By: - �4 &41-).
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�;- DAVIE COMITY HEALTH DEPART.^iENT
ENVIRONMENTAL HEALTH SECTION
P. O. BOX 57
MOCBSVILLE, N.C. 27028
(704) 634-5985 (•-
may.
Statement for Septic,Tank Improvements Permits and/or`Siter,`Eyvvaluations
NAbIE DATE s
ADDRESS Cox /66 PER14IT 14,0
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EXPLANATION Or CHARGE ' F//Ve
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AI4OUIJT D � 1 SAtJITARIAN
PLEASE RU1IT THE ABOVE Ai4OUNT ON RECEIPT.OF THIS STATEnNT. :
*NOTICE: Evaluation(s) can not be completed until payment is received.
Improvements Permit(s) can not be issued until payment'is received.