P2210 Riverdale RdDAVIE 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
Date
Name 1/ < <nff !/'' j ! /lamCr c
2-211.0
Location, f!r` ;ter/� i%�( �'r-- �!'r. /.�'. f'6✓ �(
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home �'� Business Speculation
No. Bedrooms No. Baths - No. in Family
Garbage Disposal YES C❑ NO I Specifications for System: I
Auto Dish Washer
Auto Wash Machine
Type Water Supply
YES ❑ NOrC---- �
YES (Er NO C❑
.F'.
*This permit Void if sewage systerr
y
within 36 months from dafe of issue.
w
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
Certificate of Completion / D Date 57 `112149
"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
11OCKSVILLE, N. C. 27028
(704) 634-5985
`Statement for Septic Tank Improvement Permits
and/or Sit Eva uat' o s
NAME Lif1.' r DATE ISSUED
ADDRESS PERMIT N0.
Explanation of charge
AMOUNT DUE SANITARIAN -7L
PLEASE REMIT THE�ABOVE AHOUNT ON.RECEIPT OF THIS STATEMENT.