P2407 Peoples Creek Rdr
DAVIE COUNTY HEALTH DEPARTMENT
��jj""�� IMPROVEMENTS PERMIT AND CERTIFICATE OF
''Nch4�fissued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Name c't .%.r.�; / //.,� Dae
Location
COMPLETION
Permit Number
2 -07
Subdivision Name Lot No. Sec. or Block No.
Lot Size
House Mobile Home
_ Business Speculation
No. Bedrooms
No.
Baths Y No. in Family
Garbage Disposal
YES
❑ NO
Specifications for System
`,r' %-,,-�
Auto Dish Washer
YES
d NO ❑
j';' rte::-- _._ 4ya
Auto Wash Machine
YES
❑ NO ❑
�f
Type Water Supply�'�',
-,
"This permit Void if sewage system described below isnot 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 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. j
w' 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 ' 2 tl• 0 fS
Location 1'.
Subdivision Name
Lot Size t House
No. Bedrooms �'=� No. Baths r
Garbage Disposal YES ❑ NO
Auto Dish Washer YES Q NO ❑
Auto Wash Machine YES E] NO ❑
Type Water Supply
Lot No
Sec. or Block No.
Mobile Home Business __ Speculation
No. in Family_
Specifications for System:
a � - � i � r✓ : � i
*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��1�
Certificate of Completion -==-%l 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 DEPARTMENT
ENVIRONMENTAL HEALTH SECTION d �1
P.O. BOX 57
MOCKSVILLE, N.C. 27028,
(704) 634-5985
4
STATEIMITT FOR SEPTIC TANK IMPROVEMENTS PERMITS AND/ORITE EVALATIONS
NAIL f�LS�t%�L 1" 1010d (NDATE
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ADDRESS .TI PERMIT NO. o
S N
11
EXPLANATION OF CHARGE
A�
a
A211OUNT DUL of SANITARIAN
PLEASE REIMIT THE ABOVE AMOUNT OF 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.
DAVIE COUNTY HEALTH DEPARTMENT
PERCOLATION TEST RESULTS
DATE 4 — / o - S��2
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LOCATION (DrP PjUPt'(-S GZMk (Zf�
FINDINGS: HOLE NO.
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3. DIZ� 10 �v
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By:
COMMENTS
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