159 Raintree Road Lot 7DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT;; AND `;CERTIFICATE OF COMPLETION
*Note: Issued. in. Compliance with G.S.-of North Carolina Chapter 130—Article 13c.
PermitNumber
Name Wi:i��f1 11 tee, I Date �' 1 1 1. k; 2089
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Location �1
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DAVIE COUNTY HEALTH DEPARTMENT 3� a
P. 0. BOX 57
MOCKSVILLE, N. C. 27028 (J
(7 04) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME U � � �j DATE ISSUED /
1 71
ADDRESS C `� �' �/( PERMIT NO. r q /
Explanation of c4arge
n
\ AMOUNT DUEG�)tj. SANITARIAN
PLEASE RD-4IT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT'.