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P2779 Hwy 801N
*%Note: issued, in Name Location o..a DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION Compliance with G.S. of North Carolina Chapter 130—Article 13c. Permit Number 2 -) U t_c_.,_-Date '_ 3 _b — N f ,I GArJt'r iZn �-,F�" lila t)©ops Subdivision Namle Lot No. Sec. or Block No. Lot SizeHouse Mobile Home _ Business Speculation No. Bedrooms No. Baths No. in Family 2– Garbage Garbage Dispos 1 YES 0 NO 0ca:o� ilL� Specifications for System: Auto Dish Washer YES NO 0 6�P Auto Wash Machine YES NO 0 Type Water Supply _— *This permit Voi if sewage system described below is not installed within 36 months from date of issue. •�- 1 � Improvements permit by SPFAS 6 aaCL�� Ca N�b� lf� RCf�i of S}+Sftir�.•. *Contact a repr sentative 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. Finaj Installation Diagram: ,,a) LJ,0. �cee-9-- MOO System Installed by � "" D -A O� Certificate of Completion' Date 'The signing of this certificate shall indicate that the system describ d above has been installed in compliance with the standards et forth in the above regulation, but shall in NO way betaken as a guarantee that the system will function satisfactorily f r any given period of time. f�£�G DAVIE COUNTY HEALTH DEPARTMENT PERCOLATION TEST RESULTS _ ILI /TX (Zv &F -,Z -DuL-L- ��y-3sGt WE�c� yL Z TION '/gam MINGS : HOLE NO../ . C0144ENTS P" 2. ,5113. `l oVl;--- L % `� G , q 2� . 4 S. 6. By: LOT DIAGRAM 0 3 0 v' 0 i S Aftu 4 - DAVIE COUPITY HEALTH , DEPARTMENT ENVIRONMENTAL HEALTH SECTIOti r � P. 0. BOX 57 MOCXSVILLE, N.C. 27028 (704) 634-5985 Statement for Septic Tank Improvements Permits and/or Site Evaluations DATE ' ADDRESS* / �'I PEPIUT ILIO. EXPLANATION OF AMOUrJT=0`7 . SANITARIAN PLEASE REMIT THE ABOVE AMOUNT ON 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.