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218 Dyson 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 House Mobile Home _ Business Speculation No. Bedrooms 3 No. Baths No. in Family =' Garbage Disposal YES ❑ NO ❑ Specifications for System: Auto Dish Washer YES ❑ NO [g,-- Auto ---Auto Wash Machine YES ❑ NO C❑ Type Water Supply _— `This permit Void if sewage system described below is not installed within 36 months from date of issue. _ n �,•( 1 ( r J5`' Improvements permit by �l ir�.J, '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 ------------- r Certificate of Completion ix '= �� K/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 COMMIT HEALTH DEPARTMOT PERCOLATION TEST RESULTS DATE 9- I ? - 9 NA.A M, d LOCATION FIUDINGS: HOLE NO. COMMITS ~�1 r 3 5 6 By: 11IZ ate- .�. LOT DIAGAMI Al z3�v' , 14 �t S DAVIE COUNTY HEALTH DEPARTMENT P. 0. BOX 57 HOCKSVILLE, N. C. 27028 (7 04) 634-5985 Statement for Septic Tank Improvement Permits and/or Site Evaluations NAME _1-7, DATE ISSUED �^! 7F ADDRESS 6,4,,52 PERMIT NO. )Zt-�/ n-,ct_ Explanation of charge S:.4, AMOUNT DUE SANITARIAN YN-" PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.