P2500 Holiday Acres`4 DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION;
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 130.
Permit Number
Name Date
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size ,`:f'` House Mobile Home _ /- Business Speculation
No. Bedrooms No. Baths % No. in Family
Garbage Disposal YES ❑ NO p "'. Specifications for System:
Auto Dish Washer YES ❑ NO p'� - r
Auto Wash Machine YES 0 NO ❑
Type Water Supply'_ --
1f
*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 VC 6,& 1�0&Art,
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.
/
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IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION.
~Note: |aauod in Compliance with G.S. of North Carolina Chapter13U--Adio|e 13c.Permit Number
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, .=".",Date
Location
`
Subdivision Name Lot No Sec. or Block No
Lot Size House -___-_-_ Mobile Home /'- - Business _-_ Speou|adion
No. Bedrooms - No. Baths No. in Family
---��--- |
Garbage Disposal YES [] ND E]'~
Specifications for System:
~~
Au1o.DiehVVanhar YES [-I NO [D -
Auto Wash
D'AutoVVauh Machine YES E]~ N �E]
Type VVotor Supply
Y '
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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Improvements permit bv ^
°Contacte representative of the Davie Ouunh/ Health Department for final inspection of thisisystem between 8:30-
9:30 A.M. or 1:00'1:30 P.M. on day of completion. Telephone Number: 7O4'G34'5985. !/
Final Installation Diagram:
C} /|
System Installed bv IN
Codi�uaheofComp| i `` ate
"The signing of this certificate shall indicate that the oyah*m 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 l
NAIAE
LOCATION
FINDINGS: HOLE NO. COI,RL ENTS
,5V 4.
S. j
6.
By:
LOT DIAGRA!,f
DAVIE COMITY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
P. 0. BOX 57
MOCRSVILLE, N.C. 27028
(704) 634-5985
Statement for Septic Tank Improvements Permits and/or Site Evaluations
NAME >% f", �1 f DATE
ADDRESS PEP14IT 140.
EXPLANATION OF CHARGE / ; ',' '��, 'r', ts�` ✓� ' ,% . �
AMOUN`E DUE r i' �� SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluations) can not be completed until payment is received.
Iriprovements Permit(s) can not be issued until payment is received.