P2627 Indian Hills yr
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*N6te: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name Z2, r`%; 4 i Datery
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home — Business Speculation
No. Bedrooms No. Baths -` No. in Family
Garbage Disposal YES p NO
Specifications for System:.
Auto Dish Washer YES 4 NO p
Auto Wash Machine YES Cil NO. p
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
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*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 �
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Certificate of Completion �� n.i�1') 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 \,
ENVIRONMENTAL HEALTH SECTION C�
P.O. BOX 57
MOCKSVILLE, N.C. 27028
(704) 634-5985
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STATE17 FOR SEPTIC TANK IMPROVEMENTS PE&MITS AND/OR SITE EVALUATIONS
NAME DATE
AT e
ADDRESS` kr�25z� �--- daetea• PERMIT NO...,�,9L..,Z
EXPLANATION OF CHARGE , , POOP
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AMOUNT DUE JA SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT OF 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.
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DAVIE COUNTY HEALTH DEPARTMENT
PERCOLATION TEST RESULTS
DATE a /
NAME
LOCATION
FINDINGS: HOLE NO. COIR-IMNTS
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LOT DIAGRAI,i
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DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
P.O. BOX 57
t
r MOCKSVILLE, N.C. 27028
. (704) 634-5985 a
STATFI FOR SEPTI TANK IMPROVEMENTS PE1;4M1TS AND/OR SITE EVALUATIONS
ds
NAPS ,S" DATE
ADDRESS PERMIT NO.J.
EXPLANATIO14 OF CHARGE r _
AMOUNT DUES, /r SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT OF 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.