819 Greenhill Rd (2) DAVIE COUNTY HEALTH DEPARTMENT
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IMPROVEMENTS. PERMIT AND: CERTIFICATE OF COMPLETION
`Note: Issued in Compliance with G.S. of North Carolina Chapter 130-Article l3c.
-� Permit- Number
Name i �e?/ ' ,` ��. 6�',,`' •'lo fi`' .Date2170
Locati _
iit
Subdivision Name Lot No. Sec.'or Block No.
Lot Size House /r /
Mobile Home — Business __ Speculation
No. Bedrooms No. Baths No. in Family
Garbage.Disposal YES ❑ Er--'NO [ " Specifications for System:
Auto Dish Washer `. YES ❑ NO 'O"'"��
Auto Wash Machine YEAS 0 NO
Type Water Supply
*This permit Void if sewage system described below is not installed within 36,';months from date of issue.
i
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jl
jImprovements 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 ,1:0-'1:30 P.M. on day of completion. Telephone Number: 704` 634-5985.
Final Installation Diagram: System Installed by
,I.
r „ ,
. Certificate of Completion Date 7
,'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. .i. -
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57 n/ d. /
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MOCKSVILLE, N. C . 27028 (�
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME &-OtOA41-11r rC DATE ISSUED !�
.r�''
ADDRESS PERMIT NO- ,-,TIM _
Explanation of charge
AMOUNT DUE SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.