P2684 Bowden RdDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Date Z�
Name « r: , -
Locationy-A 1
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Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _' Business Speculation
No. Bedrooms -Z-
Garbage Disposal
Auto Dish Washer
Auto Wash Machine
Type Water Supply _
No. Baths `% No. in Family.
YES ❑ NO ❑-..-
YES p NO ❑
YES p NO ❑
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Specifications for System: YOO Gr.(t::vj f7lvjy
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*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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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:
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System Installed b�?' - t�� �� 100t
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Certificate of Completion) Xnf/,41/7� Date 4,0
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'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.
9
DAVIE COUNTY HEALTH DEPARTP4ENT
PERCOLATION TEST RESULTS
DATE-
NAM
LOCATION V 1 .S Avyh-we-c_ -SA, (&Z,5— 6e 't -o
FINDINGS: HOLE NO.
2.
4.
S.
6.
LOT DIAGRAM
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COP-24ENTS
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DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
P. 0. BOX 57
MOCKSVILLE, N.C. 27028-
(704)
7028(704) 634-5985
Statement for Septic Tank Improvements Permits and/or Site Evaluations
ADDRESS i��• c� P
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EXPLANATION OF CHARGE] 5111 1
DATE 1/- 17 - �r �
PERMIT 140. H 4 '/
AMOUNT Dura 11,'`„ SANITARIAN 15P S
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be completed until payment is received.
Improvements Permit(s) can not be issued until payment is received.