110 Dayspring WayDAVIE 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 � %% �;/1:!, rr t;f;'•, ,f� Date
Location �i��',,�-:�'� •` .'-;. ; ,yam<�i- �'
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 p-"""-
Specifications for System:
Auto Dish Washer
YES ❑
NO ❑�'`J
�. `-"��t ,% :/
Auto Wash Machine
YES p
NO__.❑
^
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
('
o
Y.
4
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
Certificate of Completion )' / tel/ 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.
DAVID; COMITY HEALTH DEPARTNlEI3T
PERCOLATION TEST RESULTS
DATE _
NAWILlE
LOCATIOIN
FINDINGS: HOLE PIO.
LOT DIAGRAZI
4
S
6
By:
CO:ir'J OTS
DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONME11TAL HEALTH SECTION �. CA
P.O. BOX 57 � �r
MOCKSVILLE, N.C. 27028
(704) 634-5985 `L-
STATEMEIJT FOR SEPTIC TANK IMPROVEMENTS PERMITS AND/OR SITE EVALUATIONS
NAt4E J ,% DATE
4z
ADDRESS P` CT/ PERMIT NO.
via
EXPLANATIOI4 OF CHARGE
AMOUNT DUi •
r
0
SANITARIAN
PLEASE REMIT THE ABOVE A14OUNT 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.