946 Yadkin Valley Rd (2)1 �
' DAVIE COUNTY HEALTH DEPARTMENT
'4 IMPROVEMENTS' PERMIT AND CERTIFICATE OF COMPLETION
`Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Namet / /.�..: J;% y` /r� % `- Date
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size'? �` House Mobile Home '- 'l Business Speculation
No. Bedrooms = No. Baths =`- No. in Family
Garbage Disposal YES ❑ NO Or Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Machine YES E) NO -❑ {
Type Water Supply
`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 Diagrai
14 2 - / /Z I'f 4,/
System Installed by �c,6-
�• � rr
Certificate of Completion • �r" Chi o . Date r S g
"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.
s
DAVIE COUTI= HEALTH DEPARTMENT
PERCOLATION `,PEST RESULTS
DATE�f2��11
LOCATION
FID1DINGS : HOLE 110.
s
6
LOT DIAGM
`� 1
CO:.ME I S
;*4,
DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
P. 0. BOX 57
l MOCB,SVILLE, N.C. 27028-
(704)
7028(704) 634-5985
Statement for SepticTankImprovements Permits ander/or Site Evaluations
NAME --����=� Z�� l/7 DATE
ADDRESS PERP3IT iQO.
EXPLANATION OF CHARGE
AMOUNT DUE
SANITARIAN
PLEASE REMIT THE ABOVE Ai40UNT ON RECEIPT OF THIS STATEMENT.
*NOTICE: - Evaluation(s) can not be completed until paynent is received.
,Improvements Permit(s) can not be issued until payment is received.