176 Duard Reavis Rd ` DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
' Permit Number
Name Date 7- °: 22145
Location :
Subdivision Name Lot No. - Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms 3 No. Baths No. in Family
Garbage Disposal YES ❑ NO p Specifications for System: acro �s ��--�`-
Auto Dish Washer YES p- NO ❑ r�`t. (��,, j� �. -��y
Auto Wash Machine YES NO ❑
Type Water Supply _
*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
*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.
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Final Installation Diagram: System Installed by llFi
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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.
DAVIE COUNTY HEALTH DEPARTMENT
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PERCOLATION TEST RESULTS jw� -
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DATE 7-f� -7
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LOCATIM
FIINDIiNGS: HOLE 140. CO—IiMENT-S
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By:
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DAVIE COUNTY HEALTH DEPARTMENTC��
P. 0. BOX 57
MOCKSVILLE, N. C. 27028
(7 04) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME -,,,,,,�, ,a,Q,�,�/�� DATE ISSUED
. ADDRESS PERMIT NO. 22./ 3
Explanation of charge
AMOUNT DUE 1 SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.