P4828 Ruby Berry�. L.:.• � -_,. ,-.:—_+,.+�,,.'�..�-....� � w..::� ,:...- , :+ ti:i;:.a.. .. . nim ariw+I:v y " i...,'^ 3:�'•..�- -..,. ii.. _�_��a:;,.+,�... .-.. .. .., . .. ..-,.,....�.r ...�.... ,.w. ........,
DAVIE COUNTY HEALTH DEPARTMENT
�
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION i
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name
Location r -'r
Date
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
Auto Wash Machine YES ❑ NO ��1�(% —!'�
Type Water Supply
lr
*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 —1�^—
Certificate of Completion otl n �-� = JDate
*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 reddTation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
STATEMENT
DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
210 HOSPITAL STREET
P. 0. BOX 665
MOCKSVILLE, NORTH CAROLINA 27028
(704) 634-5985
DATE 6-23-87
Ruby Berry
P. 0. Box 56
Advance, NC 27006
..Site Eval. & Permit 4828 - $40.00
L
DETACH AND MAIL WITH YOUR CHECK. YOUR CANCELLED CHECK IS YOUR RECEIPT.
6-23-87 1 Site Eval. & Permit 4828/Ruby Berry $40.00
BALANCE DUE — I $40.00
STATEMENT
DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
210 HOSPITAL STREET
P. 0. BOX 665
MOCKSVILLE, NORTH CAROLINA 27028
(704) 634-5985
DATE 7-23-87
F
SECOND NOTICE
Ruby Berry
P. 0. Box 56
Advance, NC 27006
Site Eval. & permit 4828 - $40.00
L Billed 6-23-87
DETACH AND MAIL WITH YOUR CHECK. YOUR CANCELLED CHECK IS YOUR RECEIPT.
BALANCE DUE — 1 $40.00