P2430 Daniel Rdrs - DAVIE 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
Namely Date' d''E,0
Location 7 s- a4. �`5�,,,_ls�c� r -'- r�.,. �, �r�t —
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 ❑ NO El Specifications for System: i7DC\CO Yak
Auto Dish Washer YES ❑ NO ❑ ci�
Auto Wash Machine YES ®' NO ❑
Type Water Supply —�' ;• u ,�. �, ---
• o-
*This permit Void if sewage system described below is riot 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 Diagram: System Installed by hx"A ---
lI vn
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.
DAVIE COUNTY HEALTH DEPARTMENT
PERCOLATION TEST RESULTS
DATE 5 - % to - ?b
NAME
LOCATION �1lv.e�s ?oo..a
I
FINDINGS:
a 6s" --
LOT DIAGRAM
HOLE NO.
1. 3h goti �?rn�•.��re�
2.
3.
4
S. m), b'cL a,,,.
6.
r
COMIENTS j
:+� O O OL �OQtX' (•6�p �h \ j �• � 6 a:Y � � �'gY�L�
By:
DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMEN'T'AL HEALTH SECTION
- P.O. BOX 57
MOCKSVILLE, N.C. 27028
(704) 634-5985
STATEMENT FOR SEPTIC TANK IMPROVEMENTS PERMITS AND/OR SITE EVALUATIONS
NAME !K ��c c.. .� e, w. e S - - -- -- DATE_
ADDRESS �%' 1. 5a PERMIT NO. 2430
r-,�OPPL' n..t - -2.7
EXPLANATION OF CHARGE % A k: 'CJ -D- d -
AMOUNT DUE SANITARIAN
PLEASE REMIT THE ABOVE AMOUINT OF 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.