126 Chunn Ln 30.`
DAVIE COUNTY,-HEALTH DEPARTMENT
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IMPROVEMENTS-PERMIT til ND CERTIFICATE OF COMPLETION
'Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13e.
Permit Number
;i498
r Name Date ,..-
Location
Subdivision Name Lot No. __ Sec. or Block No.
Lot Size. House Mobile Home _ Business Speculation
No. Bedrooms. No. Baths _ Noin Family I' `
I
Garbage Disposal YES ❑ NO [.�'' 11
Specificatiofor� em:
Auto Dish Washer YES NO E] '; ' � �
Auto Wash Machine YES NO C]
. Type Water Supply�/�,fdJ �� iii --
'21il- A0 >4
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'This permit.Void ifsewage systim 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 by1�QQ`� Y4�Mb/�
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Certificate of m letion DateT
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*The signing of this certificate,shall indicate that the stem describ above has keen installed in compliance with
the standards set forth.in the above regulation,;but sh II in NO way be aken'as a guarantee that the system will function ;
satisfactorily for any.given period-of time �� }
DAVIT' COMITY HEALTH DEPARTMENT
PERCOLATION TEST RESULTS
DATE
NAM
LOCATION
FINDINGS: HOLE NO. MMMEES
2 Av `/1� c dl S
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By:
LOT DIAGRMf
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DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
P. 0. BOX 57
MOCRSVILLE, N.C. 27028
(704) 634-5985
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Statement for eptiq T Improvements Permits a r Si e E�va�cu�ations
NAME DATE
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ADDRESS tPERMIT IJO. !
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EXPLANATION OF CHARGE �' � �d' e/
AMOUIr, DUE SA14ITARIAII
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PLEASE REMIT THE ABOVE A14OUNT ON RECEIPT OF THIS STATE,'4ENT.
*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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