4281 Hwy 158 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 j r . 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 O NO p.--' Specifications for System:
Auto Dish Washer YES F1 NO p
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.
61
0
R
Improvements permit by > =,,% f`"
c
"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
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 COMITY HEALTH DEPARTIKENT "-
ENVIRONMENTAL HEALTH SECTION `�.,�,
P. O. BOX 57
MOCKSVILLEr N.C. 27028-
(704)
7028(704) 634-5985
Statement for Septic Tank Improvements Permits and/or Site Evaluations
NAME
E10L l / DATE
ADDRESS PEP1-1IT 140. �4SlL —z
EXPLANATION OF CHARGE ZZ 2c/n ,
AMOMU DUE, SANITARIAN
PLEASE REMIT THE ABOVE A14OUNT ON RECEIPT OF THIS STATEIMENT.
*NOTICE: Evaluation(s) can not be completed until paynent is received.
'Improvements Permit(s) can not be issued until payment is received.
DAVIE COUPJTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
P. O. BOX 57
MOCKSVILLE, N.C. 27028-
(704)
7028(704) 634-5985
Statement for Septic Tank Improvements Permits and/or Site Evaluations
PtAr9E__--r' DATE '-
zz
ADDRESS-' --��� PERMIT IJO.
EXPLANATION OF CHARGEf � �_
AMOUNT DUE SANITARIAN
PLEASE REMIT THE ABOVE WIOUNT ON RECEIPT. OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be completed until paynent is received.
Improvements Permit(s) can not be issued until payment is received.