P2486 Milling 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.
Name �<t t•) jt 'i ��I R%l���r..�
Location
Subdivision Name
_ Date
Permit Number
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Lot No. Sec. or Block No.
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Lot Size ! �_ `- House Mobile Home _`'� Business Speculation
No. Bedrooms ez..- No. Baths No. in Family _
Garbage Disposal YES ❑ NO p Specifications for System:
Auto Dish Washer YES ❑ NO p (�
Auto Wash Machine YES ❑ NO z -%r -
Type Water Supply (x)'J [ aj --- _[1. �? E'. � u 1J (A
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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Improvements permit by
in
'Contact a representative of the Davie County Health Department for final inspection of this systefn between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. III
Final Installation Diagram:
System Installed by
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Certificate of Completion a`� Date C
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*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.
DOME COMMIT HEALTH DEPARTMENT j
PERCOLATION TEST RESMTIS
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DATE
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DAVIE COUNTY HEALTH DEPARTMENT
ENVIROI.MENTAL HEALTH SECTION
+ P.O.-BOX 57
MOCK9VILLE,. N.C. 27028
(704) 634-5985 _
STATEMENT FOR SEPTIC TA14K IMPROVEMENTS PERMITS AND/OR SITE EVALUATIONS
NAPS �� ? V �i O �-t�j $ r n• DATE .
ADDRESS Pty"' S6 . NO.4 t4 �Cj_
EXPLANATIO14 OF CHARGE �...
AMOUNT D � O^ SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT OF RECEIPT OF THIS STATEMENT.
*NOTICE Evaluation(s) can not be complated until payment is received.
Irmrovements Permit can not be issued until payment is received.