555 Ijames Church Rd DAVIE COUNTY HEALTH DEPARTMENT �
IMPROVEMENTS PERMIT- AND; CERTIFICATE ,OF COMPLETION
"Note: Issued'in Compliance with G.S. of NothlCarolina Chapter 130—Article 13c.
i' Permit :Number
Name ,,&Va 'KDoOlt- Date \n / } '�� !';�,�, ` 2?®4
111 '
Location
Subdivision Name ' Lot No. Sec. or Block No.
Lot Size y q q G:LY 4 House ✓ .!:Mobile Home'._ Business Speculation
No. Bedrooms No. Baths IZ No. in Family
Garbage Disposal YES p NO V1 Specifications for System: 1 du�'��at1v►,'S-Ta''`
Auto Dish Washer YES [;?" NO p' tq) 71=1
Auto Wash Machine YES NO
Type Water Supply _ v c c
j I,
*This permit Void if sewage system described bell w is not installed within 36 months from date of issue.
Improvements permit by �� �11a l
*Contact a representative of the Davie C t 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 co Telephone-Number: 704.-634 5985:'
Final Installa n Diagram: Insta e b �• \
At 9?? XWO
f '^ , Certificate'of Completion:' Date
'The`signirig�of''this ce tificattb shallindicate'Ithat 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 COUIITY HEALTH DEPARTMENT
PERCOLATION TEST RESULTS
DATE 10/24/79
NA.*,E William D. Koontz 998-8950 Route 21 Box 220 Mocksville
LOCATIo,,d I,james Church Road off highway 601N approx. 1.3 miles on left
2.199 Acres
riNDINGS: HOLE 11O. CO:Nic UTS
1 ,12 X30 _ �o�� Prpos�ed 4 bedrooms 2j bath
2 y f 3v - /2d So.� ('tmcx.E.�f•.S: �o�so.l - g- 1 sr-c�ec p (`ecQ
'�.. edls $t��so.l -a�5a AecP rLcYF.7%
1 3
3 GU ' juw/ir-- 8\.�1�-ll, VASV�- A ff -a-,Vt UN—S rune
c..,\ - N��L cL 1 oo-v� - 6eccry e-s
c3 ewe.._ r�V-4
It I
S ct�j t at So-f r o C kt- o, 3 b-Je .
By: v .
LOT DIAGIWI
D &D
,0.
46
P
DAVIE COUNTY HEALTH DEPARTMENT
ENVIRON14EITTAL HEALTH SECTION
r ` P.O. BOX 57
MOCKSVILLE, N.C. 27028
(704) 634-5985
STATEIIE14T FOR.SEPTIC TANK IMPROVEMENTS PERMITS AND/OR SITE EVALUATIONS.
NAM , William U• Koontz DATE ICl 24/49
ADDRESS Route 21, Dox 220 PERMIT NO. 2n04 4
t•Jocks ille, fiJ.C. 27028
EXPLANATI014 OF,CF:ARGE Situ Evaluation and ImprovcmionL•a earmiC
A?'4OUNT DUE MAO _. -SANITARIAN Mande
PLEASE REMIT THE ABOVE AMOUNT OF RECEIPT OF:THIS STATEIAE14T.
*NOTICE: Evaluation(s) can not be completed until payment is received.
Improvements Permits) can--not be issued until payment is received.