P2564 Duke Whitaker Rdv
DAVIE COUNTY HEALTH DEPARTMENT .
IMPROVEMENTS IIPERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S.:of North Carolina Chapter 130 -Article 13c.
Permit Number
Name ///K Y ii Date /./ �/ �`' 2564
Location Jl/�C� C�'i,.,r"aI k /�' /"d' F` l r',F""f
.
Subdivision Name III Lot No. Sec. or Block No.
I.
Lot Size_ 'House ffII�, Mobile Home _ �usiness Speculation
No. Bedrooms No Baths I—h No. in Family.. sS
Garbage,Disposal YES NO p Specifications for System:
Auto Dish Washer' YES NO
Auto Wash Machine YES,, p NO E
Type .Water Supply
"This permit Void jf sewage- system described below is not installed within 36 months from date of issue.
Iimprovements permit by
_ '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
L _ �,
4P
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
satisfactoril for an even enod of time.
DAVIE COUNTY HEALTH DEPARTMENT
PERCOLATION TEST RESULTS
�ii 40
i /- - - tow
LOCATION
FINDINGS:
HOLE NO.
LOT DIAGRAM=i
4.
S.
6.
By:
C01,24ENTS
oed
0
10 17
DAVIE COU ITTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
P. O. BOX 57
MOCKSVILLE,_N.C. 27028-
(704)
7028(704) 634-5985
Statement for Septic Tank Improvements Permits and/or Site Evaluations
NAME
a6�,��t��'ss"' � 'itT='�h�---- DATE___ I�%i/
ADDRESS PEP14IT 140. . . f �
EXPLANATION OF CHARGE
AMOUNT DUE VO SANITARIAN
s
PLEASE REMIT THE ABOVE A140UNT ON RECEIPT OF THIS STATEME T.
*NOTICE: Evaluation(s) can not be completed until payment is received.
Improvements Permit(s) can not be issued until payment is received.