167 Overlook DriveDAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
MOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
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NAP:E�����'�� DATE ISSUED �/6-77
ADDRESS ,y, g PERtdIT NO.
Explanation of charge II &0ex, „ _ -2 r,,A _
AMOUNT DUEfL56 0 SANITARIAN QkC o
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.