149 Griffey Trail (2) � - DAVIE COUNTY HEALTH DEPARTMENT
OA t IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
`Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name i�dc'uP., �, tri. Date
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home Business Speculation
No. Bedrooms . No. Baths No. in Family -
Garbage Disposal YES ❑ NO E].-
Specifications for System:
Auto Dish Washer YES ❑ NO fl i J ` �,
Auto Wash Machine YES p--NO ❑
Type Water Supply
`This permit Void if sewage system described below is not installed within 36 months from date of issue.
1
If
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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. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by `
I
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/�fj,
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.
1
DAVIE COUNTY HEALTH DEPARTMENT
PERCOLATION TEST RESULTS
DATE
NAME
LOCATION S�(� ���"� `'�,._1,�, — - l ►w.� , -f -
FINDINGS: HOLE NO. CO1•24ENTS
2. r.• 1.
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4. Sd�, a� �►-- \o �'�ra�� "mac��-,
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6.
LOT DIAGRMl
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DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONI MTTAL HEALTH SECTION
... . . �: P.O. BOX 9t !o S'
MOCKSVILLE, N.C. 27028
(704) 634-5985 �J y .
STATEMIT FOR SEPTIC TAI4K IMPROVEMENTS PEMMITS AND/OR SITE EVALUATIONS
NAPE WA%r-vp- Sw- a.- DATE
ADDRESS r7� _ 3 {��[ t(- ' 66--'�PERMIT NO. .7
Ife-
EXPLANATIOII OF CHARGE
AMOUNT DUE SANITARIAN- � • �
C�1
PLEASE REMIT THE ABOVE AMOU?dT OF RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be completed until payment is received.
Improvements Permit(s) can not be issued until paym6nt is received.