P2555 Hwy 801NDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
`Note: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c.
i Permit Number
Name r� 1 i% rfes- %,dr Date-"'-'f``;.%'���1.� 2 5 5
LocationA,; ;W—
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Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms No. Baths . =l No. in Family
Garbage Disposal YES ❑ NO ❑' Specifications _for, System:
Auto Dish Washer YES NO
P Y �
Auto Wash Machine YES NO ❑ ` 4 _ `,�✓
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months-firom date eoofissue..—
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Improvements permit by
*Contact a representative of the Davie Cou/ty Health epatment for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of comple 'ron. ele one Number: 704-634-5985.
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Final Installation Diagram: °�/ / j System C9-orrS Cao Installed by Y
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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.
/ r
LOCATION
DAVI FE COUI3'l'Y HEALTH DEPARTME14T
PERCOLATION TEST RESULTS
MIDINGS: HOLE 140. COMMMITS1 ll
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DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
P. O. BOX 57
MOCK.SVILLE, N.C. 27028
(704) 634-5985
Staten.e for Septic Tank Improvements Permits and/or Site Evaluations
IMSE .14444 DATE AP -49 - 106e
P
ADDRESSPERMIT INTO.
EXPLANATION OF CHARGE
A14OUNT DUr6 SANITARIAN''��
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be completed until paynent is received.
Improvements Permit(s)-can'-not be issued until payment is received.