P2503 Hwy 901W•=• 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
Name
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41
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is not installed within 36 months from date of issue.
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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.
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Certificate of Completion
*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.
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Specifications for System: / ='L' Cr?L
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is not installed within 36 months from date of issue.
r) a j L c s
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.
J%)NloflL '„� itMo
Final Installation D'iagramf System Installed by7jcraN'�t
5►2€D k-0 P- �i 5A, IfoUsr
/ + a
ILIr-
'7 (At.t D
2t/4
�;96 Date-- 1J b
Certificate of Completion
*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.
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DAVIE COUNTY HEALTH DEPARTMENT
PERCOLATION TEST RESULTS
DATE -7-1(-7()
NAME
LOCATION
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FINDINGS: HOLE NO.
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By: 4�4S
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( DAVIE COUNTY HEALTH DEPARTME
EP]VIRONMENTAL HEALTH SECTION
P. O. sox 57
MOCRSVILLE, N.C. 27028-
(704)
7028(704) 634-5985-
Statement for Septic Tank Improvements Permits and or Itte FVYations
NAME DATE
ADDRESS33�O" - PERMIT 140. ZS'0-3
HPrf�.vwon�y h1 G
EXPLANATION OF CHARGE Iwo
ATM
on 02 0a FA od
AMOMM D �SANITARIAN
PLEASE REMIT THE ABOVE A14OUNT 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.