P2132 Bobby Barness
DAVIE COUNTY HEALTH DEPARTMENT i
IMPRVVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
�D � � � � ,��%�/� S Permit Number
Name Date
Location
Subdivision Name
Lot No. Sec. or Block No.
Lot Size P<�a-CA e-4---' House Mobile Home ✓ Business
No. Bedrooms Z No. Baths No. in Family
Garbage Disposal YES ❑ NO
Auto Dish Washer YES ❑ NO ❑
Auto Wash Machine YES ❑ " NO ❑
Type Water Supply
Specifications for System:
Speculation
*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 ' 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 DEPARTi4ENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME
/ i�"�i /���;li DATE ISSUEDj'
ADDRESS PERMIT NO.
Cie�CG /Y (7.
AMOUNT DUE �
SANITARIAN
PLEASE RE14IT THE ABOVE AlIOU14T ON RECEIPT OF THIS STATEMENT.