277 Pine Ridge Rd A DAVIE COUNTY HEALTH DEPARTMENT ` �
3
` IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'Note:-Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name Date
LocationC`,. .
Subdivision Name Lot No. Sec. or Block No.
Lot Size House "` Mobile Home _ Business _— Speculation
No. Bedrooms L No. Baths No. in Family
Garbage Disposal YES ❑ NO Q-- Specifications for System:
Auto Dish Washer YES p" NO ❑ ,, -;. ' _ ;, ,' o 1 Ute _
Auto Wash Machine YES 0. NO ❑
Type Water Supply _--
r
"This permit Void if sewage system described below is not installed within 36 months from date of issue.
7
%I jJS fit Y n (j✓�7>r. - S�S�G-.`-
i. �)
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 byf) r `< �� •%• � .
i
1
A J�
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.
� l
f
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations ,
NAME DATE '-ISSUED
ADDRESS ��;�G �} � �33� PERMIT NO.
Explanation of charge `j,�e F� �(. 41 S:"_
AMOUNT DUE �aao,A SANITARIAN �4NJ
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
1�
DAVIE COUNTY HEALTH DEPARTMiT
PERCOLATION TEST RESULTS
DATE — /9'. 7 91
NAArE ,—F 2
LOCATIOel 411 ��c /P c •�'�" (�,�,��el �.1.Y� /miffs% 2 ,�,cz,�
117-—
FINDI14GS: HOLE NO. COlNrL4EUTS
1 no �flo fie„K hales'. ►, lulu cr tett_ '�° '.Ertl
w uw�a. 40 A-ZCt4sr i CAC ' o-
2 —Te ^-
3 l� AD m, .,.
4
5
6 /p�c�. C;l•S hwcti�1..�
By: _
LOT DIAGRMM
Sl�