P2668 Howardtown Rd DAVIE COUNTY HEALTH DEPARTMENT
C : :IMPROVEMENTSI PERMIT AND CERTIFICATE OF COMPLETION
*Note:assued in Compliance with G.S. of North Carolina-Chapter 130-Article 13c.
-Permit Number
Name �'�'!1/' I f/fr.� Date /J/ /. `:' G66
Locatio ./,� .�,'s�.�r''� �ly%, d��-�' -` ." ./S
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 N0 p Specifications for System:
Auto Dish Washer. YES. NO ❑'
Auto Wash Machine -YES NO ❑
� - ..Type Water Supply /�„�- ��' ��` _ ,• .� �-'' o`'lGl"�.,(�.; .E'� � �-' ,
`This permit Void if sewage system described below is not installed within,36 months from date of issue.
• - i.. .. , Iii
p
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.
' n
Final Installation Diagram: ` (System Installed by f
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. f,;
DAVID: COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
-ry. P.O. Box 57 f C�
rzocxsvlLLE, N.C. 2702e MaP 3
(704) 634-5985
STATEMENT FOR SEPTIC TANK IMPROVEMENTS PEMMITS AND/OR SITE EVALUATIONS
NArM �':/i DATE �G..� " +l
ADDRESS PERMIT N0.
EXPLANATION OF CHARGE
AMOUNT DUE, C/i SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT OF 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.