251 Westridge Road Lot 17DAVIE COUNTY HEALTH DEPARTMENT
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IMPROVEMENTS PERMIT AND CERTIFICATE-.OF COMPLETION
*-NOTE: ;Issued in Compliance+witlh G.S:'of North'Carolina Chapter 130 Article 13c
,Sewage Treatment.,and-- Disposal, Rules 1(10 NCAC 10A .1934-.1968) Permit Number
Name Y-1-�r Date -4266
Location
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e
Subdivision Name Lot No. Sec. or Block No.
Lot.-Size' ;House ,Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES .0 • . NO E2,
Specifications for System:
Auto Dish Washer YES NO fl
Auto Wash Machine YES [�j NO -❑�-
'Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date 'of issue.OZ.
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Improvements permit bye' 1
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: System Installed byl
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' Certificate of Completion 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. , gg!
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DAVIE COUNTY„ -HEALTH
DEPARTMENT,,
(Septic Tank) Improvements Permit and Certificate of Completion
(_Ground Absorption Sewage`'Disposai-System
- G.S. Chapter 130' -Article 13C)
OWNER OR CONTRACTOR
DATE., JCIV- Y7. PERMIT
i ;LOCATION ✓ r�J + , r r, jt�c
J\ 597
S.R. -NO.
SUBDIVISION NAME LOT
N0. 44 0"1 SEC ON OR BLOCK NO.
HOUSE MOBILE:HOME E3 BUSINESS'❑
NO., BEDROOMS` NO.. BATHROOMS o� rte,
House -Trailer. 800 Gal. 400 Sq. Ft.
Two Bedroom House 800 Gal. 600 Sq. Ft.
:.GARBAGE DISPOSAL UNIT YES. ',❑ NO.., Q'
Three -'Bedroom- House 900 Gal. 900 Sq'. 'Ft.
AUTO. DISHWASHER: YES:”"- NO ❑
Four Bedroom House 1000 Gal. 1200 Sq. Ft._
AUTO. WASH. MACHINE, YES ., •12''' NO ❑
'NO
SITE ,SUITABLE YES. .❑
SIZE OF TANK. al.
:NITRIFICATION FIELD sq. ft.
'DEPTH
OF STONE IN LINES:
WATER SUPPLY:,- -Individual ❑ Public
:IMPROVEMENTS PERMIT BY ;'� ``�.; ...a ...
INSTALLED BY
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
MOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAP4:E j :L,,LI(r ��,,_�,1,ti DATE ISSUED �)•iq--77
ADDRESS :? < ;, \._. �.z �. (,t_„�_ PERI..IT NO. /S(17
Explanation of charge
AMOUNT DUE ` jS:d73 SANITARIAN �_ r(Nct—,,O
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.