P2462 Vanzant 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
Name Date Z ' %� r� E �°. 6 2
Location ° `'�/tel / r'�� �'� ,+s .� i .���r .��r� :��t� %%:Jf%<-5
Subdivision We__�72%f '�!'r'/ ��r�Lot No. Sec. or Block No.
Lot Size House m Mobile Home _ Business Speculation --
No. Bedrooms f No. Baths , J No. in Family
Garbage Disposal YES ❑ NO Ej -- Specifications for System:
Auto Dish Washer YES ❑ NO
Auto Wash Machine YES [:]--NO ❑
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 `
*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:
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System Installed by�
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Certificate of Completions Date
"The signing of this certificate shall indicate that the system described above has been iristalled 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 DEPAR774ENT
PERCOLATION TEST RESULTS
LOCATION
FINDINGS:
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LOT DIAGRAM
HOLE NO.
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4.
S.
6.
COMIENTS
Val
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DAVIE COMITY HEALTH DEPARTMENT
EPIVIRONMENTAL HEALTH SECTION
P. 0. BOX 57
MOCKSVILLE, N.C. 27028--
(704)
7028(704) 634-5985
Statement for Septic Tank Improvements Permits and/or site'Evaluitions '
NAME � ,, , .::- �--r.�t-� DATE�11F� . �.
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ADDRESS '- / PE. RP -SIT 140.
EXPLANATION OF CHARGE /� .�/ ek
AMOUN DUE %� 7 . f o
s SANITARIANZ- �f
s:
PLEASE REMIT THE ABOVE A14OUNT ON RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be completed until payment is received.
Improvements Permit(s) can not be issued until payment is received.