145 Valley Oaks Drive Lot 19 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 .�.w.w�ti ilIi�•,S'vy,,.<...r-�A Date 2689
Location _
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Subdivision Name V�a 1\c Oo Itz Lot No. Sec. or Block No i
Lot Size 12- 1 }� "
House ✓ Mobile Home — Business Speculation
No. Bedrooms 3; No. Baths -2 No. in Family-- ;.
Garbage Disposal YES ❑ NO p!
Specifications for System: 'po�Q1��.-" rVL
Auto Dish Washer YES p-' NO-
Auto
O Auto Wash Machine .YES ❑--NO, -❑
Type Water Supply
*This permit Void if sewage system described below"is riot installed within'36 months from date of issue.
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Improvements permit by. !)C•
'Coritact a representative of the Davie County Health Department for final inspection of this system between 8:30-
9:30 A.M. or 1:004.30" P.M. on day of completion. Telephone Number: 7041-634-5985.
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Final Installation Diagram: ( `3� "' f��� System Installed by ����GAj'r^ w�+h
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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 givenyperiod of time.
DAVIE COUNTY HEALTH DEPARTMENT
PERCOLATION TEST RESULTS
DATE
NAME-
LOCATION //i.
FINDINGS: HOLE NO. COF2i4ENTS � G�
2.
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BY:
LOT DIAGRAt,i
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