P2537 Wendell BurtonDAVIE COUNTY HEALTH DEPARTMENT
l IMPROVEMENTS PERMIT AND -CERTIFICATE OF COMPLETION
*Note: Issued in -Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name'%' �' i/� Vii% !` i�r ,... Date % //i /l " c'� 5.
Location
Subdivision Name
Lot No.
Lot Size %%'�f House /'�,, Mobile Home
No. Bedrooms No. Baths No. in Family.
Garbage Disposal
Auto Dish Washer
Auto Wash Machine
Type Water Supply
YES :❑ NO
YES ❑ NO
YES ❑ NO p
Sec. or Block No.
Business Speculation
Specifications for System:
*This permit Void if sewage system described below is not installed within 36 months fr&n 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>i-,--- �-4nt)A`1Zf K1 -
A<<
Certificate of Completion , 1L�^ Date
*The signing of this certificate shall indicate that the system describ�cj' 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 DEPARTMENT
NVIRONMENTAL HEALTH SECTION
P. 0. BOX 57
M_OCRSVILLE r N.C. 27028-,
(704) 634-5985
Statement for Septic Tank Improvements,:Permits and/or Site Evaluation's
DATE
ADDRESS ' j , PERMIT 140.���
c
r
EXPLANATION OF CHARGE
AMOUNT DUEL SANITARIAN r
PLEASE REMIT THE!ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
*NOTICE: EvAluation(s) can not be completed until payne is received. j
' Improvements Permit (s) can not be issued until a
,.. p-ymsnt is received.