382 Speer 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 Date
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size f /2c-ice House r" Mobile Home _ Business Speculation
No. Bedrooms 3 No. Baths -Z- No. in Family
Garbage Disposal YES ❑ NO 0 Specifications for System:
Auto Dish Washer YES NO ❑ j4 ;"-r �=
Auto Wash Machine YES R—NO ❑
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
V
In
1
�L
z+
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: Ube 3 t I y` System Installed by
Certificate of Completion �� ��� r?' Date
*The signing of this certificate shall indicate that the system described 5above 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.
T�t
DAVIE COUNTY HEALTH. DEPARTMENT
ENVIRONMENTAL HEALTH SECTIO14
P. 0. BOX 57 ,
MOCRSVILLEr N.C. 27028
(704) 634-5985
Statement for Septic Tank Improvements Permits and/or Site Evaluations
YJAIIE -t)0!f, 2 r e u CA 4- DATE k$--0'0
ADDRESS �1�n,► G y` 2 PEP14IT 140. 37 5
EXPLANATION OF CHARGE / Y4�
AY•OLU.-L DUE sZIPi6l� SANITARIAN
PLEASE REMIT THE ABOVE A14OUNT ON RECEIPT OF THIS STATE,,%MNT.
*NOTICE: Evaluation(s) cannot be'--,completed until payment is received.
Improvements Permit(s) can not be issued until payment is received.