P2202 Peoples Creek Rd= DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'*Note: Issued ip Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Lot, Size /i'
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'
Permit Number
Name /1 r i�ir✓
ijj l''l - --5
1 Date
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Location
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Subdivision Name
Lot No.
Sec. or Block No.
Lot, Size /i'
– House;
'
Mobile`Home _ Business Speculation
No. Bedrooms
y' No. Baths
f
.No. iri Family
j
Garbage Disposal YES ❑ NO ❑
�tt Specifications for System: yrs
Auto Dish Washer YES p NO,❑
Auto Wash Machine YES NO C] �.
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Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue. nn
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Improvements permit by. 1"7 J;
*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
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 COUTTY HEALTH DEPARTMENT
PERCOLATION TEST RESULTS
DATE /
LOCAZION
FINDINGS:
1
2
3
LOT DIAGIWI
HOLE 140.
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i
COMMYNTS
Ale-
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LL
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DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
MOCKSVILLE, N. C. 27028
(704) 634-5985
i
Statement for Septic Tank.Improvement•-Permits
.and/or Site Evaluations
NAME /�.�/DATE ISSUED
ADDRESS PERMIT NO.
-- Explanation of charge
_ A'TIOUNT DUE SANITARIAN l—
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.