2185 Milling Rd DAVIE COUNTY HEALTH DEPARTMENT
v; IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name -L i�J _ 'r�.,C .1 Date 7 2"8
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Location n , t r r 1 Cr /fir: ^+✓ !�- ._. :� r-; %]; iY ir;i,1, C.✓:t l�
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home Business Speculation
No. Bedrooms -S No. Baths No. in Family f
Garbage Disposal YES ❑ NO p' Specifications for System:
Auto Dish Washer YES ❑ NO ❑ '
Auto Wash Machine YES ❑ NO ❑
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 ` '
`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.
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Final Installation Diagram: System Installed by
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Certificate of Completiornr t7, Date
"The signing of this certificate shall indicate that the system descr bId above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way b3e taken as a guarantee that the system will function
satisfactorily for any given period of time.
DAVIE COUNTY HEALTH DEPARTPdENT
PERCOLATION TEST RESULTS
DATE -I " Z 7
NP14E LPIJ`1 T3 AV-0 S,,—
LOCATION
FINDINGS: HOLE NO. C01MENTS
10,E SPR�, 1. Sue,—e,— Iy `�
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By:
LOT DIAGRAPs
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DAVIE COMITY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
P. 0. BOX 57
MOCKSVILLE, N.C. 27028-
(704)
7028(704) 634-5985
Statement for Septic Tank Improvements Permits and/or Site Evaluations
NAbmE—PiLN N h !�ARw `j DATE
ADDRESS 1�T` r7"]� ( PERMIT 140.
1VW GL'S�1 U.� I G `LZ °y�
EXPLANATION OF CHARGE ,l �r T �V WA�`�'" ' � � �-Zoyrf vZF-v��
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AMOUNT DUI . SANITARIAN,o. c
PLEASE REMIT THE ABOVE AMOUNT ON 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.