P2439 Davie Academy 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 � \) , A , Got-( l i I!'` r R- Date 2 4, a
Location ��l1 Ut i �1 c r"\ r->r�-'� fly"i�R-�F:. ��. fn'i r t s l'l�. v=-4 J g 21 t o
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Subdivision Name// Lot No. / Sec. or Block No.
Lot Size e !4 House Mobile Home Business Speculation
No. Bedrooms '71 No. Baths No. in Family
Garbage Disposal
Auto Dish Washer
Auto Wash Machine
Type Water Supply
YES ❑ NO Efl
YES ❑ NO
YES M NO C❑
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Specificattiions forSystem
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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
7-411
*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:
I System Installed by
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Certificate of Completion 0'�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 DEPART?/lENT
PERCOLATION TEST RESULTS
` ` 50"
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FINDINGS: HOLE NO.
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DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
P O. BOX 57 - ` ( -
j, MOCKSVILLE, N.C. 27028
�•�'� (704) 634-5985"
STATEMENT FOR SEPTIC TANK IMPROVEMENTS PERMITS AND/OR SITE EVALUATIONS'
NAPS. .,�� �...� t ti P� �� �.�_ DATE
ADDRESS J 7 `7 �h •:l U PERMIT NO. �/ J
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EXPLANATIO14 OF CHARGE Z' V1J 1(f/1-`(7 tom..
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AMOUNT � � SANITARIAN
PLEASE MMIT 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.