521 Brushy Mountain Trail DAVIE COUNTY HEALTH DEPARTMENT
t� IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name Date - L vel r r 1;
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Location 54 7d eo C.7, !a .sir r:��> ;,";,;�'t.�
Subdivision Name �!1 /' �1N I►AjI Lot No. Sec. or Block No.
Lot Size `0 ` Housey`r Mobile Home _ Business Speculation
No. Bedrooms l~ No. Baths z No. in Family
Garbage Disposal YES p NO p Specifications for System: F00
Auto Dish Washer YES (D NO fl ! "
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Auto Wash Machine YES (h NO fl �'� X /.Z S"t o r�
Type Water Supply l.L _ LD - 130'x or.! 600e'17�7 4" Stf?is
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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Improvements permit by {r��Js
*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 --
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(J° Certificate of Completion 1 Date
*The signing of thicc tificate 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.
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DAVIE COUNTY HEALTH DEPARTMENT
PERCOLATION TEST RESULTS
G3��L
` DATE
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LOCATION
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FINDINGS: HOLE NO. COIZENTS
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By:
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DAVIE COMITY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
P. 0. BOX 57 I
MOCKSVILLE, N.C. 27028-
(704)
7028(704) 634-5985
Statement for Septic Tank Improvements Permits and/or Site Evaluations
Nwe 6UY CoR oA7 7 EIZ- # :�Q, DATE
ADDRESS 127' z 577 PEFt-UT 140.
A7>VANCS NC 7-70o(i
EXPLANATION OF CHARGE
R iwuT- 14
A140MIT X90 SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be completed until payment is received.
Improvements Permit(s) can not be issued until payment is received.