P2480 Cornatzer Rdr• .
DAVIE COUNTY HEALTH DEPARTMENT
l;'IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name r''i� Date ." =�r `r? 2 3
/ r
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size '� -`<'� House Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family�yl—/j f/ — �`J��
Garbage Disposal YES ❑ NO ❑ �,�j�'
Specifications for SystemG{� :y
Auto Dish Washer YES ❑ NO ❑ --`� , , ' "�"�' ,'�f'<<%'
Auto Wash Machine YES ❑ NO ❑ '._.
Type Water Supply �1r.'.�__ ; -/{f It 'i ;'t ir' .�/,;`%��5,
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by _ �` r� �° _ •
*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 by
n_
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.
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DAVIE COMITY HEALTH DEPARMIENT
PERCOLATION TEST RESULTS
DATE /O - 31) - 7 9
10 S-, 6,1& r79
NA:. -M 4el-s' a7/07
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6-K �t �' r! C•wf�� IV '� n - k sG g
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LOCATION /d — �� - �L � . p� G�'zd't'- 'ew —
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FINDINGS: HOLE 110.
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COMMITS
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DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
P.O. BOX 57
MOCKSVILLE, N.C. 27028 b c((»>
704 -59
( ) 6 4 3 85
STATEPQE FOR ,SEPTI TANK ;IMPROVEMENTS PERMITS AND/OR SITE EVALUATIONS
NwZ �i�/GDATE
ADDRESS�'?'j/C" fE'� PERMIT N0.
EXPLANATION OF CHARGE
AMOUNT DUE CO 00 SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT OF 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.