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P2282 Hwy 158:,.DAVIE- COUNTY HEALTH DEPARTMENT Y IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION "Nbrd. Issued in Compliance with G.S. of"North Carolina Chapter 130—Article 13c. 71 Permit Number Name Date .< _82. Location Subdivision Name Lot No. Sec. or Block No. Lot Size House _� Mobile Home_ Business — Speculation No. Bedrooms No. Baths r_v No. in Family Garbage Disposal YES NO .� Specifications for System: Auto Dish Washer. YES © NO ,� .1 _ Auto Wash Machine YES NO E]_r Type Water Supply'.iJp� _ "This permit Void if sewage -system described below is not installed within 36 months from date of issue. - Improvements prmtt 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: 3 System Installed by; 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 DEPARTMENT P. 0. BOX 57 MOCKSVILLE, N. C. 27028 (704) 634-5985 Statement.for Septic Tank Improvement Permits and/or Site Evaluations NAME 1'�!�-c. .�� 7 /tjC ' / DATE ISSUED V/ %! ADDRESS Expllanation of charge AMOUNT DUE PERMIT NO. 4 % G, SANITARIAN ;"`% h] PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.