P2126 Pine Ridge RdDAVIE COUNTY HEALTH DEPARTMENT
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IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Name..: R ��i ��t ���;� ,� Date
Location C) ' t'\ f
Permit Number
2126
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms No. Baths t No. in Family
Garbage Disposal YES O NO E].— Specifications for System: `�, �• <3 ' ;.>_(? ic} ,, 5;
Auto Dish Washer YES (D— NO ❑
Auto Wash Machine YES p' NO ❑
Type Water Supply c1 _
*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
111,W X'/a
G
Certificate of Completion ! ; c�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 `
P. 0. BOX 57 Id
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAMEGt,\�„^S DATE ISSUED
ADDRESS PERMIT NO.
C<, eQ- V\ (" _-;, I 16 \A
Explanation of charge
VA QaN-•- c r'. i�T o {` f� _ �t� — `i'P 1�iik —3oaF i 1 AGi ► u. iz-z {.a�
AMOUNT DUE O2 0SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT Oi�Fif THIS STATEMENT.
DAVIE COUTIM HEALTH DEPARTMiT
PERCOLATION TEST RESULTS
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DATE_?'. C, n,n , Col G=av,,
NAVE ?-C) "621
LOCATION N
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FINDINGS :
LOT DIAGIWI
HOLE NO.
2 Qun--/o
3
4
5
6
COMMENTS
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