P2397 Gladstone RdDAVIE COUNTY HEALTH DEPARTMENTI y�
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
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Name ►� h�_ i i ti r Date �' c t.'
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size t��� ^ i -, _ z_ House Mobile Home Business Speculation
No. Bedrooms ' No. Baths No. in Family rs
Garbage Disposal YES ❑ NO p'` Specifications for System: e� :J :
Auto Dish Washer YES ❑ NO ❑
Auto Wash Machine YES E.; NO -❑
Type Water Supply f 4 "
`This permit Void if sewage system described below is not installed within 36 months from date of issue. ,
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 e - A L ( L C �'
Certificate of Completion 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 DEPART?,IENT
PERCOLATION TEST RESULTS
DATE °
LOCATION 'i'aclj),ne 1&,r4--
FINDINGS:
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FINDINGS:
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DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONl1TAL HEALTH SECTION
P.O. BOX 57 Cl
MOCKSVILLE, N.C. 27028
(704) 634-5985
STATEMENT FOR SEPTIC TANK IMPROVEMENTS PERMITS AND/OR SITE EVALUATIONS
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NAPS d 9 F-,� �. (� 1 :1n lel N DATE
ADDRESS`�'• O '�v �'a'� PERMIT NO. c7.37 7
f 0d v -m;rC ,N•'. d701k}
EXPLANATION OF CHARGE g -le E•�nL'. -� 'S �'C . � ut,�'
AMOUNT DUE 01UD SANITARIAN �• m�
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.