738 Dulin Rd ii 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
Date
Name I �: t �'ti� :�r,,.,
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 p
Auto Dish Washer YES E] NO �❑_.
Specifications for System: :F �� 'y , � • •
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 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.
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Final Installation,Diagram: System Installed by
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Certificate of Completion n,, :, Date `p- 2a
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*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.
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DAVIL COUTNTY HEALTH DEPARTMENT
�IPERCOLATION TEST RESULTS
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PIUDINGS: HOLE 110. COMMENTS
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LOT DIAGRAM
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DAVIE COMITY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
P. O. BOX 57
MOCKSVILLE, N.C. 27028-
(704) 634-5985 •
Statement for Septic Tank Improvements Permits and/or Site Evaluations
NAbfE�''~�_ I'1`�L�:..� _ DATE
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ADDRESS �qo� COIt�.`Lw. CIk� PEPMIT 140. ZSSi
EXPLANATION OF CHARGE .�
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AMOUN- DUE 2c,-00 SANITARIAN �0 ,
PLEASE REMIT- THE ABOVE IU40UNT 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.