P2521 Howardtown 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
NameDate - r.
Location
Subdivision Name Lot No. _ Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms No. Baths ';2 No. in Family
Garbage Disposal YES ❑ NO ❑ Specifications for System: .
Auto Dish Washer YES ❑ NO ❑ - J
Auto Wash Machine YES ❑ NO ❑
Type Water Supply
*This permit Void if sewage system described below is not irist la led-wilthin 36 months from date of issue.
Improvements permit by
*Contact a representative ofihe Davie CouAty Heath Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 PAN On day of cbmpletion . Telephone Number: 704-634-5985.
Final Installation Diagram:
1
System Installed by
J
Certificate of Completion��'<=�
*The signing of this certificate shall indicate that the system described above
the standards set forth in the above regulation, but shall in NO way be takeys'
satisfactorily for any given period of time. 11
Date
)as been installed in compliance with
i guarantee that the system will function
DAVIE COMMIT HEALTH DEPARTMiT
PERCOLATION TEST RESULTS
DATE l
NA."M
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LOCATIO11.1
FINDINGS:
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COMMITS
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By:
DAVIE COU .N TY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION VA
P.O. BOX 57
MOCKSVILLE, N.C. 27028
(704) 634-5985
STATE14ENT FOR SEPTIC TA14K IMPROVEMENTS PERMITS AND/OR SITE EVeALUATIONS
NA11 DATE
ADDRESS -�-- PERI4IT NO.
EXPLANATION OF CHARGE ./!Ii � � ///.ril'_ ��� !] _ t /�,�' �+ • '�
AMOUNT DUE_,Q2OD SANITARIANY„i/°'
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.
4