P2579 Granada Driveb DAVIE COUNTY HEALTH DEPARTMENT
r `# IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
`Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name ,11i'Y/ f /.� !;/C� Date
Location
Subdivision Name 3VOOCLVO_16i ? Lot No. Sec. or Block No.
Lot Size 42 House , Mobile Home �� Business __ Speculation
No. Bedrooms No. Baths_ No. in Family
Garbage Disposal YES,,[] NO p-
�ecificatio s Sy tem:
Auto Dish Washer YES NO p� /✓
Auto Wash Machine YES b NO C] / !r
Type Water Supply
*This permit Void if sewage
ed within 36 months from date of issue.
G
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:
)9
System Installed by
Certificate of Completion � �� C^'\1_D Date L2- /2 - �'e)
*The signing of this certificate shall indicate that the system describe 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 ,
NATIIE
LOCATION
LOT DIAGRAM
HOLE NO.
z. Peel✓ ,,` s
3.
4.
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6.
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COMIENTS
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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
_ -DATE ISSUED07 / �M)
PERMIT NO. /
NAME Ol
ADDRESS.1�k'
Explanation of charge `
�C
ATIOUNT DUE,*;,r. SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.