P2218 Doug Spry1
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'Not .: Jssued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
' Permit Number
Name Date
Location ', 4f , fr tr f"
Subdivision Name Lot No. Sec. or Block No.
Lot Size �/%� House �''"Mobile Home _ Business Speculation
y ''r
No. Bedrooms'"° No. Baths No. in Family
Garbage Disposal YES NO
g p ❑ ❑� Specifications for System:,'�,��ra
Auto Dish Washer YES ❑ N O
Auto Wash Machine YES E NO ❑
Type Water Supply /ir��.,�, _ '��C 9/�''�
li
`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'-
17
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. . )
JM/
DAVIE COU11M HEALTH DEPARmMiT
PERCOLATION TEST RESULTS
DATE
LOCATION
` FINDINGS :
1
2
3
LOT DIAG2 I
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ROLE 140. /
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0
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3
COMMITS
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By:
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
MOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permit`" //I
and/or Site Evaluations
NAME DATE ISSUED
ADDRESS7- PERMIT NO. zi;
Explanation of charge R `
AMOUNT DUE06 SANITARIAN L
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.