P2526 Howell RdDAVIE COUNTY HEALTH DEPARTMENT
II, .,_.�
IMPROVEMENTS PERMIT* AND CERTIFICATE OF COMPLETION
'Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name i:. , '� , ; , r �'�: - Date p
c_.
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size �' ' ' f House Mobile Home ="�~ Business - Speculation
No. Bedrooms No. Baths frf No. in Family
Garbage Disposal
Auto Dish Washer
Auto Wash Machine
Type Water Supply
YES .p NO []''
YES 0 NO 0
YES [ I NO 0
Specifications jor System:
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by'�'� -
*Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
'/ I
Final Installation Diagram: System Installed by ►J�f�1'F �'�S
Certificate of Completion{{ / Date
"The signing of this certificate shall indicate that the system descri d .above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way bAaken as a guarantee that the system will function
satisfactorily for any given period of time.
li
.r
DAVIE COMMIT HEALTH DEPARTI-MliT
PERCOLATION TEST RESULTS
DATE O lJ
NA'�� /7C'iP �/i¢PSD.�r/ -//Iy �r�� �`�Ff' o e. �P.�i✓2�sv Ile
LOCATION
FINDINGS:
LOT DIAGRAM
2
HOLE 140.
C0.7MENTS
7,-, �(V
:DAVIt COUNTY HEALTH= DEPARTMENT
tNVIrtdNMENTAt HEhZ—TH SECTION
P.O. BOX 57
MOMSVILLEo- NX., 27028 1 i
(764) 6345965.
STATEMENT FOR SEPTIC, TA14K IMPROVEMENTS. PERMITS' AND/OR SITE. EVALUATIONS
HAIM, DATE.
ADDRESS PERMIT N&_
EXPLANATIO14 OF CHARGE Z1.24
A�HOUNT DUE12 SANITARIAN.. i! 01-L
PL=E'REMIT THE MOW' AMOU414T -OF RECEIPT OF -THIS STATEMENT..
*NOTICE: Evaluatio'n'(s), can i6i be. completed.. uniil Payment is- received.
Im.rovemahts, Permits) can not be,issued until payment is received.