P2295 Riverview RdDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*No`?.I;�;:0--d in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name '� r.'e ,�� f ,;, Date i-''"/ – f ��'� 22SS
Location
a
Subdivision Name'--',� �/ j'r -` x `` Lot No. Sec. or Block No.
Lot Size /='',/` House
Mobile Home Business Speculation
j)
No. Bedrooms No. Baths No. in Family
Garbage Disposal
Auto Dish Washer
Auto Wash Machine
Type Water Supply
YES ❑ NO [D
YES El NO ❑
YES] NO i❑
Specifications for; System:
h
*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:
I/•
System Installed by
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 COUllM. HEALTIi DEPARMIENT
PERCOLATION TEST RESULTS
DATE //— _ — %
NXIE
LOCATION_ef
FINDI.1GS : HOLE 140. CW MENTS
3
4
5
6
By:
LOT DIAGRMI
L
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
MOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME �;; � / /ly' DATE ISSUED
ADDRESS PERMIT NO.
Explanation of charge
O
AMOUNT DUE�,�//SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.