372 Fairfield 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 fj' :c' +/ 't/i 1.- Date - '%��fy' " �
' 54
Location _
Subdivision Name Lot No. Sec. or Block No.
Lot Size �%' %!f'�J HouseMobile Home — Business Speculation
No. Bedrooms -' No. Baths No. in Family ='
Garbage Disposal YES ❑ NO p~'' Specifications for—System.,
Auto Dish Washer YES [] NO ❑ �' ;f ,�.:.,r f``
Auto Wash Machine lYES ] NO ❑ r '' _-, f fes,
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
*Contact a.representative of the Davie County Health Department for final inspection of this system between 8:30-
9:30 �A:M._.o`r 100-1:30,.P.K on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by
C7_
6"
Certificate of Completion 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
ENVIRObIMENTAL HEALTH SECTIO14
—, P.O.. BOX 57
MOCKSVILLE, N.C. 27028
(704) 634-5985 31/9/
t
STATEMENT FOR SEPTIC TA14K IMpROVEMEIMS PERMITS AND/OR SITE EVALUFIQNS
NAME r �~ DAT
ADDRESSa2 PERMIT NO. �
- J
EXPLANATIO14 OF CHARGE
AMOUNT DUE SANITARIAN r ;
PLEASE REMIT THE ABOVE AMOUNT OF RECEIPT OF THIS STATEMENT.'
*NOTICE: Evaluation(s) can not be complAed until payment is received.
Irmrovements Permit(s) can not be issued until payment is received. ;