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397 Griffith Rd^.;.` DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *.Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c. Name !/i JI Cc f, Location i 5 ` eft JL �� j1 L�. 7� 1 f r Date Z--1%- 'i"U Permit Number 2,- 4or"N 17011r> Subdivision Name Lot No. Sec. or Block No. Lot Size ' House Mobile Home _ �-� Business Speculation \ No. Bedrooms No. Baths No. in Family '7-- _ Garbage Disposal Auto Dish Washer Auto Wash Machine Type Water Supply YES ❑ NO Q YES ❑ NO [D YES p NO ❑ L L Specifications for System: goo ('RCLCh1 7'`1je j I) - Goy �00/ x 3" ,-, 1Z" sre, "L *This permit Void if sewage system described below is not installed within 36 months from date of issue. Si 1 1 C M JI �ALL,003 jko t-) ) ()'O` r 4C)rV'LrJ LI, t z�--- Improvements permit by �o. *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 01 �2 Certificate of Completion /° �f'i� Date —Zi -- *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 COMMIT HEALTIi DEPARTMENT PERCOLATION TEST RESULTS DATE NAA �I� N 1 S V V 5 �-1 C� �9 O- �g 3'9 LOCATION FINDINGS: HOLE 210. COMMITS 1 1.a„ PR.ESCAe 2 10 "' f2/LfsoAK S�✓f��-- 3 F(II- L- 7D 1/f i�0— %bP 4 5 6 LOT DIAGM%i L,3voipf P 5toK P©c'>t'j rrtu -- rlLw.r GPkx�P,,i5 4A t�uon- 2� K DAVIE COU1ITY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION ` P. O. BOX 57 MOCKSVILLE, N.C. 27028 /�• (704) 634-5985 Statement for Septic Tank Improvements Permits and/or Site Evaluations Y3Ab1E �D�.N N k S W• S E{ a�j DATE 2- ZCv &0 ADDRESS PERMIT 140. 7341 q EXPLANATION OF CHARGE 4 1-0-r ✓ ' J � `�` l """ P� J ''" AMOUNTfU1,;2:::j0• � SA14ITARIAN 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.