747 Chinquapin Rd (2) 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
N
Name =' "''" - Date 'Ile -
i
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size -r'r`. ' House Mobile Home _ -"" Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES ❑ NO p�r
Specifications for System:
Auto Dish Washer YES ❑ ANO p-'Ty"
Auto Wash Machine YES ❑✓, NO ❑ r „f,�
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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. Z.
Final Installation Diagram: System Installed by
_ 1 /
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 COUNTY HEALTH DEPARTMENT
PERCOLATION TEST RESULTS
DATE
LOCATIOi1
FINDINGS: HOLE 110. CMIDPIEt1TS
3� !
62 6
Py: .�
LOT DIAGM
3
DAVID; COUNTY HEALTH DEPARTMENT
ENVIRONMEIi'i'AL HEALTH SECTION
P.O. BOX 57
MOCKSVILLE, N.C. 27028
(704) 634-5985
STATE12I4T FOR SEPTIC TANK IMPROVEMENTS PE&MITS AND/OR SITE EVALUATIONS
NAME �1ct4�s[ L��-� DATE - +Or
ADDRESS _ 1�J ",��' PERMIT NO.
EXPLANATION. OF CHARGE
Cv
AiWUNT DUE SANITARIAN
ti
PLEASE,REMIT THE ABOVE AMOUNT OF RECEIPT.OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be completed until payment isoreceived.
Improvements Permit(s) can not 'be issued until payment is- received.