601 Hillcrest Drive Lot 5 Section 2C . .
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
MOCKSVILLE, N. C. 27028��, QQ
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NA14E / DATE ISSUED f
ADDRESS -7-/r_
-j � PERtr4 IT Mn
Explanation of charge
AMOUNT DUE SANITARIAN
PLEASE REMIT THE ABOVE A14OUNT ON RECEIPT OF THIS STAY'EMENT.