P2418 Jack Booe RdDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
`Not,?; f seed in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
..Name- S�_C._ �%��i'�Date Permit Number
/�w Ali .
Location
Subdivision Name
Lot No. Sec. or Block No
Lot Size %/� House Mobile Home _ Business Speculation
No. Bedrooms °/-/No. Baths � No. in Family
Garbage Disposal YES E] NO gam"' Specifications for. System:
Auto Dish Washer YES Ep NO1���;
Auto Wash Machine YES [1] 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
*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�r C(- 01 TS
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 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.
.'= J DAVIE COUNTY HEA LTH 'DEPARTPdENT
PERCOLATION TEST RESULTS
DATE
NA4E
y LOCATION
1
INDINGS : HOLE N0.04EN
C P1 � T5
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Ille
4'
6.
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1
' By:
,LOT DIAGRA4
9