P2630 Cornatzer 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
Name f')kf ij - - Date S 1 a {fl
Location
J-rL �c3d-j Z7 S C�12-0 p r✓ �?4
Subdivision Name
Lot No
Sec. or Block No
Lot Size • Housey�f Mobile Home _ Business Speculation
No. Bedrooms No. Baths _ No. in Family"
Garbage Disposal YES ❑ NO ❑ Specifications for System: 6/1 L"'''" T -A
Auto Dish Washer YES ❑ NO ❑ �•
12
Auto Wash Machine YES ❑ NO F-1° f L
Type Water Supply b -s c LC-SCt"L`
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit bys?j--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 �X?
I
Certificate of Completion -� Date
p �
*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 DEPAMENT
PERCOLATION TEST RESULTS
DATE -AA PdLC, -1 I2 1 ci Fi 11O r S Z7/a7 7 /,d
z � L NAME M (Z 1-4 F) Q, I,, Lf6 Eo s. /,K A, tj 6d , 7-8
LOCATION�QN r�i Z�fL _ 2D b ! 9--D 6F-`6-( 1-1-61"JO
6��
FINDINGS: HOLE NO. CO?RIENTS
2.
3.�{� Prc�smnG �. /O:IG
4.
S.
6.
DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMEN7TAL HEALTH SECTION
P.O. BOX 57 Z6
MOCKSVILLE, N.C. 27028 t�yjj `3 � Q. ✓�
(704) 634-5985 0
STATEMENT FOR SEPTIC TA14K IMPROVEMENTS PERMITS AND/OR SITE fEjVALUATIONS
NAP2E (SCH LLJNN DATE - �J
ADDRESS LIG•3 �• �^ '�/►�- �`� 28' PERMIT NO.2�O3"
r
EXPLANATIOI4 OF CHARGE 1 SITE E VA ` a,1 -17 a1--
�
AMOUNT DOW
2-O a-''
SANITARIAN ��Iq
PLEASE REiMIT THE ABOVE AMOUNT OF RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be completed until payment is received.
Irrorovements Permit(s) can not be issued until payment is received.