P2393 Hwy 64EDAVIE COUNTY HEALTH DEPARTMENT
/'apo
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
`Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c. I
Permit Number
i f 171.`-^`!C } J'l i �(c' L� . ,_.� �) l �/,»t';); �� ', c : �'a':= �', •>
Name Date
Location
/tlI`t'i t IcI/ �.t'i r
Subdivision Name Lot No. Sec. or Block No.
r
Lot Size _ House Mobile Home Business __ Speculation
No. Bedrooms `� `! No. Baths No. in Family _
Garbage Disposal YES ❑ NO Q Specifications for System:
Auto Dish Washer YES ❑ NO
Auto Wash Machine YESLiNO {] '
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
S',A d
VQ
CLIt
f
l� i 4 1 rti W
VJ
___... j it
,'V C
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. I,I
Final Installation Diagram:
Installed by �1�^Mn ,SI _ �`f', •,1,; n �.
. ��
Certificate of Completion Date
d
'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
/ I
LOCATION C� �E ST %zD- P4 -S ! S 7-6 W A -CL r
clvt C
FINDINGS:
1.
2.
3.
4.
S.
HOLE NO.
COMIENTS
.4,
i
I!
6. SSI
By: �
i
LOT DIAGRAM
2
0 Z
DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
P.O. BOX 57
MOCKSVILLE, N.C. 27028 ! _
a
(704).634-5985 df
STATE22I1T FOR SEPTIC TANK IMPROVEMENTS PERMITS AND/OR SITE EVALUATIONS,,
y„
NAPM L�11�r5`Ibf�f1 f iZ o P N,50d DATE
ADDRESS PERMIT N0.
EXPLANATIOI4 OF CHARGE
f
L0 ✓
Pr� �l
.s i
AMOUNT DLJL� �0: fXD SANITARIAN
PLEASE REMIT THE ABOVE AMOU?JT 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.
0