P2066 Sain RdI
DAVIE 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.
Permit Number
Name l; r' er`%�`.�' Date,' -� �� 2066
Location r
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 Cl NOp'""^
� - Specifications for ;System:
Auto Dish Washer YES ET N0 ❑ rj�
Auto Wash Machine YES EE -7-N'0
Type Water Supply��
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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Improvements permit by`>'"r� -
*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 ZZ�l ReirT
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.
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DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57 L�
MOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
- - ------ -- -- ------------and/or Site Evaluations.
J" _,- DATE ISSUED
NAME ,,�f��f/ . �/'�'!
ADDRESS����,�f PERMIT NO.
Explanation of charge,
AMOUNT DUE_ SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF
THIS STATEMENT.