165 Reece Way 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 ✓,�'' ffl; j,:,f� !>J `" ,,� Date /i' ,2 f' 7
! f
�jj
Location . r %' if i=; + ✓ f Tr �/ J//��Jci T".�,; _ �� 1 i!� '`,LJ_ —
Subdivision Name Lot No. Sec. or Block No.
f�
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms n/ No. Baths No. in Family
Garbage Disposal YES .1] NO 01-- Specifications for System:
Auto Dish Washer YES p NO E) `y
Auto Wash Machine YES p NO p
Type Water Supply --
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
JKI
.
Improvements permit by
*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
1 f \\
1
1
Date
Certificate of Completion
'The signing o ,1this certificate shall indicate that the system described aboYd/has been installed in compliance with
the standards s)et 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 DEPARTMUT
PERCOLATION TEST RESULTS
DATE �,A�9
LOCATION
FIT1DINGS: HOLE 130. COMENTS
3
V
6 —
Vo
o'
/ 1
LOT DIAGIMI
I
,l
• T:1`
' r.'.r�w��'1.., _ .r..1 r♦ ...._,.ter ..� .
y ;
y
D IE'COUNTY`HEALTH, DEPARTMENT
i` RONMENTAL.HEALTH'.SECTION' ,
J P i 0: 'BOX 57.
CKSVILLE'jNX., 27028,
(704),. 634-5985-
Statement for Septic Tank Improvements Permits ,and/or Site Evaluations
NAME
ADDRESS�`l r ti_ PEalIT• Na.
EXPLANATION OF CHARGE
A140miT DUE 5A141TARIAN:
PLEASE REMIT THE ABOVE A14OUNT ON RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) tan not bi compl6te& until payment: is received.
Improvements Permit(s) can. notbe: issued_ until payment is rscei4ed.