P2344 Howardtown RdDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note:. Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
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Name Date
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Permit Number
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Subdivision Name - Lot No. Sec. or Block No.
Lot Size (�g J^ %�c House Mobile Home _�-� Business Speculation
No. Bedrooms No. Baths G No. in Family __5
Garbage Disposal YES ❑ NO d Specifications for System:
Auto Dish Washer YES ❑ NO ❑ 1) - Lox'
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Auto Wash Machine YES ❑ NO C❑
Type Water Supply
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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
*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:
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System Installed by FFgfF I 15A -- -
Certificate of Completion �� Date Z _ ZO - g0
*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.
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DAVIE COUIM. HEALTH DEPARTMEUT
PERCOLATION TEST RESULTS
DATE
LOCATION �b 1/rAILi I 2�
FINDINGS: HOLE 110.
LOT DIAGRAM
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By: G
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DAVIE COMITY HEALTH DEPARTMENT
EPIVIRONMENTAL HEALTH SECTION
P. O. BOX 57
MOCBSVILLE, N.C. 27028-
(704)
7028(704) 634-5985 V
Statement for Septic Tank Improvements Permits and/or Site Evaluations
NAME_ 94 q 1 / 7'TA► hl DATE �2
ADDRESS 7707 6 a(6 (-tT W007 C PERI -11T NO.
(til - S N C -?,-710
EXPLANATION OF CHARGE / LO 7 rLIACUA-t7od
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SANITARIAN 2 SPt',�-s-
PLEASE RDIIT THE ABOVE X40UNT ON RECEIPT OF THIS STATEINIENT.
*NOTICE: Evaluation(s) can not be completed until payment is received.
Improvements Permit(s) can not be issued until payment is received.