185 Baltimore Rd DAVIE COUNTY HEALTH DEPARTMENT
w4`M IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carol ina.Chapter 130—Article 13c.
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Permit Number
Name Date _r��!,�� '�'/'; 2201
Location'
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Subdivision Name _ ✓ Lot No. Sec. or Block No.
Lot Size t!- k House "'" -Mobile Home Business Speculation
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No. Bedrooms - No. Baths No. in Family _
Garbage Disposal YES ❑ NO >
Specifications for System:
Auto Dish Washer YES 0--90 ❑
Auto Wash Machine YES p-140 p ,' �r r
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
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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 by L
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Certificate of CompletionDate"
'The signing of this certificate shall indicate that the system descri fed above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way b6 taken as a guarantee that the system will function
satisfactorily for any given period of time.
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DAVIE COUNTY HEALTH DEPARTMENTS
P. 0. BOX 57 t
_ IOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement .Permits
and/or Si a Evaluations
NAME DATE ISSUED I
ADDRESS /�!� '� PERMIT N0. d
1 Explanation of charge
AMOUNT DUE- . SANITARIAN
PLEASE REMIT THE ABOVE 'AMOUNT ON 'RECEIPT OF THIS STATEMENT
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