586 Main Church Rd (5) 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. /;-/411-' -- " / //�/�'/ 1�/� J 1f:' Date /1Z Z .'/'- �:• ,
/✓,fr'i✓ I c
Location if ,: �/%/ / 7,r
Subdivision Name Lot No. Sec. or Block No.
Lot Size �'� / House Mobile Home —L�� Business Speculation
No. Bedrooms No. Baths— No. in Family
Garbage Disposal YES ❑ NO p--'
Specifications.for System-
Auto
Auto Dish Washer YES NO ❑ �J - - -
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.
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.
Final Installation Diagram: System Installed by
/moo X� X� y
i
"�' %f
Certificate of Completion Date ./2'�
*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
P. 0. BOX 57
MOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME �/� (j� DATE ISSUED
ADDRESS � �''"� PERMIT NO.
Explanation of charge
0 .
AMOUNT DUE`,. , SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985_,
Statement for Septic Tank Improvement Permits
�1 and/or Site Evaluations
�� �f I/, /7 '7,
NAME DATE ISSUED
ADDRESS �_ , x
J 1 `s / r/ERMIT N0.
Explanation of charge
AMOUNT .DUE ✓" SANITARIAN
PLEASE REMIT THE ABOVE AHOUNT ON RECEIPT OF THIS STATEMENT.