119 Ken Hoots Ln DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT ; ND CERTIFICATE OF COMPLETION
*Note': Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
I' Permit Number
-2456
l0-
Name �, ;. �t�M���,��. Date � ' `d� ,,.
Locat10
.: , .x,04\ � �' . �'i:.�i^.'�S 'i�.��.�� .4����. � �•� k���. , . — ,
Subdivision Name �i, Lot No. Sec. or Block No,
Lot Size JIB �� HouseMobile Home Business. Speculation
No. Bedrooms No. Baths ► l 4 Noll' in"Family
Garbage Disposal YES E] NO ❑ l' �.
Specificat(ons, for System:..
Auto Dish Washer YES p NO p9_
Auto Wash Machine. YES p- NO p.: i Iii '
Type Water Supply -
*This.permit Void if sewage system described below is not,'installed within 36 months from date of, issue.
a
•. - `M(,L / ( ( ' � Int - `
Improvements permit.by
. � v
'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.
- al!
Final Installation Diaggram:' System Installed,;by ,r,. �� C,,,
�r \to J
x�
Certificateof Completion Date
11'
The signing of this certificate shall indicate What the system described above has'been installed in compliance with
the standards set forth in the above regulation, but'shall in N0 way be taken as a guarantee that the system will function.
satisfactorily for.any given period of time �!
y .
DAVIE COUNTY HEALTH DEPARTMENT
PERCOLATION TEST RESULTS
DATE
NAME E u ceraE Vf,,-A k h rL,
LOCATION Un4eApwSs
�:t� '"�� `Rcl�JaraCF1 �Qg►� t�� � t'Fc� eP�
FINDINGS: HOLE NO. COIRIENTS
2.
3.
4.
S.
3/q qua- 5.
�n ta�nne-
By:
LOT DIAGRAM
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DAVIE COIT.Q'!`Y HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
P.O. BOX 57 �� 1 �J
MOCKSVILLE, N.C. 27028
(704) 634-5985
STATEMENT FOR SEPTIC TA14K IMPROVEMENTS PERMITS AND/OR SITE EVALUATIONS
NAME � ugr ;a� �'t�,.ti1�t��� DATE
ADDRESS PERMIT NO.
EXPLANATI014 OF CHARGE
AMOUNT DUE a'l," SANITARIAN -i, t'1 '•n ..,���
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.