P2649 Davie Academy Rd`
DAVIE COUNTY HEALTH DEPARTMENT
. .
_ IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note. I�sued 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 r' No. Baths No. in Family
GorbageDiopoa al YES :E] NO []_--
System-
Auto Dish Washer YES NO
Auto Wash Machine YES ED NO
Type Water Supply / x
*This ponnd Void if sewage oyob»m described below in not installed within 38 months from date of issue.
- '
_
Improvements permit by
*Contact a representative of the Davie County Health Department for final inspection of this system between 8:3O -
Final Installation Diagram: System Installed by
/
^' —r�^���
`
Certificate of Completion Date
'The signing of this certificate shall indicate that the .��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 funct7
�
satisfactorily for any given period Oftime. ~ -
�w~
DAVIE COUNTY HEALTH DEPARTMENT
PERCOLATION TEST RESULTS
LOCATION
NDINGS:
HOLE NO.
a.
3.
4.
S.
6.
COIRIENTS
94=p!WmmA
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DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
P.O. BOX 57
MOCKSVILLE, N.C. 27028
(704) 634-5985
STATEMENT FOR SEPTIC TA14K IMPROVEMENTS PERMITS AND/OR SITE EVALUATIONS
NAME 1//�l��' �;%r �: y/�'"G�. f r''r.> ��/� DATE
ADDRESS ,t; �. PERMIT N0. �•^ �;"
/�, ✓lr ; i
EXPLANATION OF CHARGE r `� ; j �".., /.�✓ : %rt :' %'� <.y �;f:"t'..
AMOUNT DUE ' ��t`i' SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT OF RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be completed until payment is received.
Ir.rovements Permit(s) can not be issued until payment is received.