1288 Farmington Rd i
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issbed in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
►,, i „ , ; Permit Number
Name �' 'r` f �. Date ;
Location f%����>�., ;;: �,�. .l"t� � . / :�f� �. !r�r����,e. C
Subdivision Name Lot No. Sec. or Block No.
Lot SizeHouse"fifs�t" �'r
Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES p NO pr'sr
Specifications for System: 7 fel
Auto Dish Washer YES [] NO p
Auto Wash Machine YES 0 NO ,0 j
Type Water Supply ,'',/'i��`!%''� � __ --•��`t, i' �,�� i� `
*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 C . Date C�'/ ?'
*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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DAVIE COMITY 'HEALTH DEPARTMENT
PERCOLATION TEST RESULTS
DATE D
NJ MOM //57
LOCATION
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FINDINGS: HOLE 140. COMMENTS
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By: C
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LOT DIAGRAM
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DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
1 (704) 634-5985
Statement for Septic Tank Improvement 1 5
-- __-- - -------- -.__-- ----__-_--and/or_-Site_.Evaluations__ -_-__
NAME DATE ISSUED
ADDRESS /0/�9 PERMIT NO.
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Explanation of charge40r._,PIP
AMOUNT .DUE-✓ �% SANITARIAN
/ PLEASE REMIT THE. ABOVE AMOUNT ON RECEIPT OF T/HIS STATEMENT. ,i