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P2468 Juney Beauchamp Rd.`� 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 - -- Date f r , r Location fl='' +' '�f a1E`C. E'..i .� i f; ; ; j l J. :;t' {''��J {.... i,.:^/ � f-_• .f' �4 .175 ._,j (• � �I (.� -1 .'.•. iJ� f (i Subdivision Name �� `' Lot Size House _1 f No. Bedrooms ''� No. Baths Garbage Disposal YES ❑ NO p Auto Dish Washer YES ❑ NO i] Auto Wash Machine YES © NO ❑ Type Water Supply f% =,.•�"!."`� Lot No. Sec. or Block No. Mobile Home _ �"` Business Speculation No. in Family Specifications for System: *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: ------------ k System Installed by �`tJ� J O t'`i r"'S Certificate of Completion - '' L ' r " 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. •i s C` 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: ------------ k System Installed by �`tJ� J O t'`i r"'S Certificate of Completion - '' L ' r " 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 DEPARTPdENT PERCOLATION TEST RESULTS DATE ' r (� r NAME �'t�T�l�t�D —T—tom V� LOCATION IS FINDINGS: HOLE NO. 3. 4. S. 6. LOT DIAGRAM 1 COT,2IENTS K f DAVIE COUNTY HEALTH DEPARTMENT-' ENVIRONMENTAL HEALTH SECTION P. O. BOX 57 MOCKSVILLE, N.C. 27028- (704) 7028(704) 634-5985 Statement for Septic Tank Improvements Permits and/or site Evaluations NAME i r r , ': i " ' ' DATE ADDRESS PERMIT 140. EXPLANATION OF CHARGE i AMOUNT DUE :'= % 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. eived.