P2440 Hwy 601NWAVIC UUUNIT nr-ALIn Ur-rAKIMCNI
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note Issued in Compliance with G.S. of North Carolina Chapter 130—,'Article 13c.
Permit Number
Name- e t -a 2440.'.
D ate
Location
Subdivision Name Lot No. Sec. or Block No
Lot Size House Mobile Home Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES NO
i low: Specifications- for System: T� L)Q.
Auto Dish Washer YES E], NO [E'
3,
Auto Wash Machine YES r-1 NO
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months'; from date of issue.
f
Improvements permi
t -by
Q.
*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
/e
Dat Adi
*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 DEPARTMENT
ENVIRONMENTAL HEALTH.SECTION"
P.O. BOX 57
_ MOCKSVILLE, N.C. 27028 .8 0
(704) 634-5985 1
STATEMENT FOR SEPTIC TANK IMPROVEMENTS PERMITS AND/OR SITE EVALUATIONS
NAME- DATE.' .6 "5 Yly
ADDRESS �a�C� u ::.r .1 PERMIT NO. m?y�Va
EXPLANATI014 OF CkARdi__ � . 'i UAL C."3
AMOUNT DUE*Q$O (lD. SANITARIAN d • •,c��,
PLEASE REMIT'THE ABOVE AMOUNT. OF ,RECEIPT .OF .THIS. STATEMENT.
*NOTICE: Evaluation(s) can not be completed until payment. is. .received.
Improvements Permit (s)'can'riot be issued until payment is received.