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112 R Shore Dr (3)
DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c. 1F (�`.�� 1 { _ I G �- t- Date Permit Number �' r 2 4. Name Location ��;`- l f 1.t� .��y1C► �iy C 1 tJrL H Subdivision Name - Lot No. Sec. or Block No. Lot Size i`�'� t` `�� House Mobile Home _ Business Speculation No. Bedrooms" No. Baths 1 No. in Family Garbage Disposal YES ❑ NO ❑ Specifications for System: X700 6frLtoo� 7)v Auto Dish Washer YES ❑ NO ©?- Lc> Auto Wash Machine YES ❑ NO © �-'�. L*This � Type Water Supply permit permit Void if sewage system described below is not installed within 36 months from date of issue. is E' t� Lel j co 1, 0 r 4-t i L (-- 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 JLLl S Sc 'TIL T��tivk� om letion f[ Date Certificate of C p "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 PERCOLATION TEST RESULTS DATE V' -11 - S O NAME H o w4,a— F &,T -s LOCATION (01 N S7 terr Ar7fK-pvra44,;,kyv.J G,e££< 5. Moo/CZ &OA -C FINDINGS: HOLE NO. I- P�-1 - 2• Y (- I tA) 1 f 1 3. T(LH fAl cam. I Sl b, LOT DIAGRA14 o4 l� r COHIENTS Z4n s�otL- 'gam By: S-�c-� - 4 A�,u- 0 3 a 2 11 DAVIE COUNTY HEALTH DEPARTMENT ENVIRON..MITAL HEALTH SECTION P.O. BOX .57 MOCKSVILLE, N.C. 27028 (704) 634-5985 STATEMENT FOR SEPTIC TANK IMPROVEMENTS PERMITS AND/OR SITE EVALUATIONS NAPS ADDRESS PERMIT NO. L lac k i s f. t,! C ��Z� -7 EXPLAMTIO14 OF CHARGE AMOUNT Da 77- D_ -� SANITARIAN PLEASE REMIT THE ABOVE IU40UNT OF RECEIPT OF THIS STATEMENT. F,A•-(5 *NOTICE: Evaluation(s) can not be completed until payment is received. Improvements Permit(s) can not be issued until payment is received.