137 Burton 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.
l Permit Number
Name
.c'i:'�:�'.j 1 .�'
- Date
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size fv %�� House Mobile Home _ �Business Speculation
G'
No. Bedrooms No. Baths — No. in Family
Garbage Disposal YES ❑ NO E'1_ Specifications for System
Auto Dish Washer YES p NO ❑ `r' , ',� F - si%r
Auto Wash Machine YES 6 NO i❑
Type Water Supply 1_1�4_141 fi1 _—
*This permit Void if sewage system describ�id be ow 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 compl tion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by—, 2
U
sl
17
f _
Certificate of Completion AheL 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 0 �
P. 0. BOX 57 g` y
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME Aalleil 00DATE ISSUED
ADDRESS t PERMIT N0. «`
Explanation of charge
AMOUNT DUE SANITARIAN
PLEASE RE14IT THE ABOVE AMOUNT ON' RECEIPT- OF THIS STATEMENT.
DAVIE COUII'IY HEALTH DEPARMIIENT
PERCOLATION TEST RESULTS
DATE /p
NA.r�E �lL
s
LOCATIOidf��s
FIIIDINGS: _HOLE 140. COMMITS
er
le, ,! _
$ 9� d�ml �
6 /
Fay:
LOT DIAGRA,'�I