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DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
DAVIE COUNTY HEALTH DEP1.
POST OFFICE BOX 57
MOCKSVILLE, N. C. 27028
NAME /LZler e;, DATE ISSUED
ADDRESS7 1,5141V1 PERMIT NO
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Explanation of charge
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AMOUNT DUE=5;n w SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
DAVIE COUi1TY HEALTIi DEPARMMUT
PERCOLATION TEST RESULTS
DATE
LOCIA IOIN SY 6 /
FIIIDINGS : HOLE 140. COi,kM-JTS
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By:_
LOT DIAGIMAI
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
`Note: Pssped in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
�. • Permit Number
Name - Date
Location
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 ❑ NO [j Specifications for System:
Auto Dish Washer YES ❑ NO p
Auto Wash Machine YES �' N0 ❑
Type Water Supply __—
*This,.pumit Void if sewage system described below is not installed within 36 months from date of issue.
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Improvements permit byt,-
*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 In
System Installed by
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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.
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
NAME '/�'�' �iil'J'Q� DATE ISSUED
ADDRESS" PERMIT NO. a
Explanation of charge
AMOUNT DUE • SANITARIAN J f"
PLEASE REMIT THE ABOVE.ANOUNT ON RECEIPT OF THIS.STATEMENT.
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