P2017 Juney Beauchamp 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/ �'v .. Date
Location —A Uh Ai _
Subdivision Name Lot No. Sec. or Block No.
Lot Size ! House Mobile Home — Business Speculation
No. Bedrooms ! No. Baths i No. in Family _
Garbage Disposal YES ❑ NO p'
Specifications for System:
Auto Dish Washer YESp, NO E]
Auto Wash Machine YES p NO ❑ 4J
Type Water Supply __—
`This permit Void if sewage system described below is not installed within 36 months from date of issue.
G-�
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Improvements permit by.t-�"
'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 T\% L '�-t`^� �� �� � � /-L
i
7'X 3'
. tM1't T�
Certificate of Completion baa Q0, ` 1- Date
"The signing of this certificate shall indicate that the system described above has beers' 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
P. 0. BOX 57
MOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits.
and/or /Site Evaluations
NAME�Lj1f2, (l�V l_Z/�r DATE ISSUED //117 .
ADDRESS !x',Y_-,�-, �1 (,G PERMIT NO.
\� Explanation of charge ) �}` ��
r
A11OUNT DUE SANITARIAN '
PLEASE RE14IT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEME T.