P2081 Jack Johnson-
DAVIE COUNTY HEALTH DEPARTMENT
' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. ofNorth Carolina Chapter 13U-Adic|a13c
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Permit Number
Name Date
Location
Subdivision Name Lot No. Sec. orBlock No.
Lot Size /A House ___-__-_Mobile Home __-__._Business _______ Speculation
______
No. Bedrooms No. Baths No. in Famik/_�-�_-__
Garbage Dis000a YES NOSpecifications for System:
Auto Dish Washer YES NO 0 --
Auto Wash Machine
'~AutnVV8ShK48chino YES NO
Type Water Supply
*This permit Void if sewage system described below is not mataiiod vvKn|o 36 months from date of /xxua.
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Improvements permit bv '
*Contact a representative of the Davie County Health Department for final inspection of this system between 8:309:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
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Fi. Installation Diagram: System
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Certificate ofCompletion
'The signing of this certificate shall indicate that thesystem described bovo has been installed in nnmp|iomm* with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
DAV I E COUNTY HEALTH DEPARTMENT,
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(7 04) 634-5985
Statement for Septic Tank Improvement Permits
and/ r Site Evaluations;:
NAME DATE ISSUED
ADDRESS � �7��—� PERMIT N0. —20 1P
11 4f
Explanation of charge
�. AMOUNT DUE �� SANITARIAN r �
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.