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P2425 Hwy 801SDAVIE 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 ` `'rj�� '%�.;" Date `��— �'— % 2 Location Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home _' ~' ~ y Business Speculation No. Bedrooms No. Baths No. in Family _ Garbage Disposal YES ❑ NO D-' Specifications Auto Dish Washer YES © NO ❑ ,fo�System: Auto Wash Machine YES n NO ❑ Type Water Supply *This permit Void if sewage system described below is not installed within 36 months from date of issue. Improvements permit by - aL. *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: System Installed by -- ' / 1 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 l Y I 111111 /' � ' / 1 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 DEPAMENT PERCOLATION TEST RESULTS mom DATE NAME LOCATIONZ2 FINDINGS: /&A 1. ��1v ti p/ - ,- -y 2. 3. HOLE NO. LOT DIAGRMl COM ENTS t DAVIE COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION P.O. BOX 57 MOCKSVILLE, N.C. 27028 (704) 634-5985 STATE14EIlT FOR SEPTIC TANK IMPROVEMEWS PERMITS AND/OR SITE// EVALUATIONS NAME �jl✓�s DATE / l Z6 ADDRESS PERMIT NO. �� .4a';A,L- 1&� EXPLANATION OF CIMRGE ATIOUNT DUE , O� SANITARIAN��" PLEASE REMIT THE ABOVE AMOUNT OF RECEIPT OF THIS STATEMENT. *NOTICE: Evaluation(s) can not be completed until payment is received. Inmrovements Permit(s) can not be issued until payment is received.