181 Raintree Road Lot 10low
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DAVIE COUNTY HEALTH DEPARTMENT a'
_ IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.&.. of North Carolina Chapter 130—Article 1.3c.
I� Permit Number
Name 1 04T71,�� J�f/� 1 bate ���P a;a �= 2063
Location
Subdivision NameLot No. �� Sec. or Block No.
F Lot Size House . > Mobile Home' ,Business Speculation
No. Bedrooms -J No. Baths No. in Family
Garbage Disposal YES C] NO p^ Specifications for System:
Auto Dish Washer; YES NO fl
Auto Wash Machine -YES R--*' NO , j�j Dpi' f� � iv ,t✓c_; 7`� ,�
Type Watery Supply
7S-'
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
a
f I1
�i
li
�w ' 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 P.M. on day of completion. Telephone -Number: 704-634-5985.
Final Installation Diagram: E System Installed b
Certificate of Completion I, 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 given period of time:
AW.
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DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985 Ws
Statement for Septic Tank Impro�ment
and/or Site Site Evaluations
c ,
ADDRESS P,/A
. /
Explanation of charge
DATE ISSUED / �j
PERMIT NO. �7z
i
AMOUNT DUE SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT T