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305 Foster Dairy Rdi DAVIE COUNTY' HEALTH DEPARTMENT ` IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION� J� *Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c. Permit Number / '//�l Ji''�- �'/ � i.� Name Date Location ✓ — Subdivision Name Lot Size Lot No. Sec. or Block No. House �= "'J !Mobile Home _ Business Speculation No. Bedrooms~' No. Baths No. in Family Garbage Disposal YES ❑ NO p— Specifications, for, System:–' -� Auto Dish Washer YES ❑ NO ❑ -- ��'`�r J�- �' :ter '' 6 Auto Wash Machine YES E—NO ❑ Type Water Supply *This permit Void if sewage system described below is not installed within 36 months from date of issue. J 1, j> i Improvements 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 by z�, • I ' � U Certificate of Completion /G f> 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 DEPARWENT PERCOLATION TEST RESULTS DATE G NAME LOCATION FINDINGS: HOLE NO. 2. 3. 4. S. 6. LOT DIAGRA14 By: DAVIE COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION P.O. BOX 57 MOCKSVILLE,'N.C. 27028 (704) 634-5985. STATEMENT FOR SEPTIC TANK IMPROVEMENTS PERMITS AND/OR SITE EVALUATIONS NAME ���� DATE ADDRESS "'U> �r�; /%� PERMIT N0. EXPLANATION OF CHARGE AMOUNT DUE..;, SANITARIAN �/ Y PLEASE REMIT THE ABOVE AMOUNT OF RECEIPT OF THIS STATEMENT. *NOTICE: Evaluation(s) can not ba'complated until payment is received. Improvements Permits) can not be issued until payment is received. ji