734 Will Boone Road Lot 5DAVIE COUNTY HEALTH DEPARTMENT : 4
p' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION't1�
'Note: Issued. in Compliance with G S. of .North Carolina Chapter 130—Article _13c.
; . _ 'Permit Number
Name CYeI;���. E� SIS i' Date-�-8� - ".;fir`' 26308
Location6
Subdivision Name lu r°r X40 e - 's Lot No. �� Sec. or Block No.
Lot Size House 4-� Mobiles Home _ Business Speculation
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 R.M: on day of completion. Telephone Number: 704-634-5985,
Final Installation Diagram System Installed by
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Certificate.of Completion Date
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"The signing, of this certificate shall indicate•that the system described above has been installed incompliance 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: .
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DAVIE COMITY HEALTH DEPARTMENT 1 1�
ENVIRONMENTAL HEALTH SECTION
P. 0. BOX 57
MOCKSVILLE, N.C. 27028
(704) 634-5985
Statement for Septic Tank Improvements Permits and/or Site Evaluations
NAME �V%, L.- W— DATE 1- 5 At
ADDRESS PERMIT 14O.
tk L- 2'loiY
EXPLAIIATION OF CHARGE
A14OU14T Dur 10 ft
SANITARIAN �. Y'Y\",
PLEASE REMIT THE ABOVE A140UNT ON RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be completed until paynent is received.
Improvements Permit(s) can not be issued until payment is received.
DAVIE COUNTY HEALTH DEPARVENT
PERCOLATION TEST RESULTS
DATE /a - 2 4-0
NAME 9j.9 S%!c 1,/ow
LOCATION ZU; // fj cw r 4a4,9
FINDINGS:
LOT DIAGRAM
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