P2028 William Hall•` 4
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
`Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
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 ❑'` -Specifications for System:
Auto Dish Washer YES ❑ NO 0 --
Auto
- Auto Wash Machine YES NO ❑ ;; r'
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 Diagram:
System Installed by
Certificate of Completion L���, ���,/ Date
'The signing of this certificate shall indicate that the system described above has�een 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.
Permit
Number
Name ' /' ,� �� ��� ,.�
�, � t , .
Date � � � �' �
20.8
Location
1t. i,.
�.. �•.. j
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 ❑'` -Specifications for System:
Auto Dish Washer YES ❑ NO 0 --
Auto
- Auto Wash Machine YES NO ❑ ;; r'
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 Diagram:
System Installed by
Certificate of Completion L���, ���,/ Date
'The signing of this certificate shall indicate that the system described above has�een 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.
V- �119
P Aa
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
11OCKSVILLE, N. C. 27028
(704) 634-S98S
Statement for Septic.Tank Improvement Permits
/or Site
Evaluations
NAME 'i `�t�'l-c J j��Lc.t.G-i DATE ISSUED
ADDRESS iLC ( PERMIT N0.
Explanation of charge
1 �
AMOUNT DUE, � SANITARIAN
PLEASE REPAIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATE NT.'