1829 Godbey Rd N8. t DAVIE COUNTY HEALTH DEPARTMENT
�, fn IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
q*ONgte:` d. Cor lQhartire with,G.S. of North Carolina Chapter 130—Article 13c.
1 Permit Number
Name � ,� /'•ter �''!W Date -- ,,1 : ��', 74
' Location
Subdivision Nime` Lot No. Sec. or Block No.
U# Size Ale House 4--- _ Mobile Home Business __ Speculation
No: Bedrooms .._ No. Baths No. in Family
Disposal barba a YES NO
g � Specifications for System: ;> if� - �' .�••�`
°",Auto Dish Washer YES NO p ,;; , . f ,✓/ �„
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.
zy
_ -
Improvements permit by e'
'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
�l 1
g
:q
1 ' t
x ,I. + J
Certificate of Completion Date,
signing of this certificate shalt indicate that the system describ d above has been_installed in compliance with 1
standards,set forth In the above regulation,,but shall In NO way be taken as a.guarantee that the system will function
fief r Iv fry r ni r nnii Nf i - -
DAVIE COMITY HEALTIi DEPARTt NT
PERCOLATION TEST RESULTS
DATE �< /
NAS
LOCATION
FI1IDINGS: HOLE 130. CO:uMUS
s wx
a
s
6 /
By
LOT DIAGMM
V
I
DAVIE COUNTY HEALTH DEPARTMENT
P. O. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
yy� ��and/or Site Evaluations
NAME alx DATE ISSUED
ADDRESS Aoyl !Pi'X ,$ PERMIT NO.
Explanation of charge
AMOUNT DUE Da SANITARIAN
PLEASE RE14IT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.