P2683 Duke Whitaker 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'-t �c ��� ,.,�, Date : r! G €_fi L
Locdt'I n ;,y I f!ii L 1i r { t 1 ic.1 , 1t.)
f
-7—
Subdivision
7
t i'i`i /L. li + rr�'i. fir:' j: l : �!c'il "+ J ttc'. _.�� �!(: `'i✓ l:�+iC.c /(, -1 .
Subdivision Name Lot No. Sec. or Block No.
�_ .�,,�-
Lot Size House Mobile Home — Business Speculation
No. Bedrooms No. Baths t No. in Family
Garbage Disposal YES [j NO p/ Specifications for System: `'
Auto Dish Washer YES I] NO p7
Auto Wash Machine YES 0 NO p w
Type Water Supply _—
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
- j
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 &V� T>i t)iv `
-7: —
r
1
.J5 !
0
Certificate of Completion !v� Date Z
*The signing of this certificate shall indicate that the system descried 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
PERCOLATION TEST RESULTS
DATE `7 1 3
NAPM_PC- J)
LOCATION
4& Lor APP2ox . Zyvt11-'-S A 7bP Or- Hr LL- AcTzoss
F2aM G24�u 6L-ock- NousF
FINDINGS: HOLE NO. COM ENTS
1. Of-� K `Lt!`w� S ° 1 YF w.2-0 /Go s py Go.4
6 8"
z. �° Y �� o az /VV i v Bio
3. I
4 !20
S.
6.
By:
LOT DIAGRAP-f Q
2
b
3
n
DAVIE COMITY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
F. 0. BOX 57
MOCKSVILLEr N.C. 27028-
(704) 634-5985
Statement for Septic Tank Improvements Permits and/or Site Evaluations
NAME 1 L ! �1`{,�o ►�.� DATE 4' /t'-
ADD_RE,SS R t. Z a-IN 3A E,- � PERMIT 140.
, oc�S�lLLE NL
EXPLANATION OF CHARGE Sl!c t%f1LV �w- ! �/►"f���r` �
� -S
A14OUNT D06,0 !� 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.