5051 Hwy 601NDAVIE COUNTY HEALTH- DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION _
Note: Issued in Compliance with G.S. 'of North Carolina Chapter 130—Article 13c.
Permit Number
Name j}c� �:t' �s\��.e� Date.y0
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size ca dV r I N _ House , Mobile Home - Business Speculation
No. Bedrooms 3_— No. Baths — _`No. in Family _
Garbage Disposal YES Ej" NO ❑ ��� X11. •-ro-lt
Specifications for System:. 1
Auto Dish Washer YES 0' NO ❑ a -t VS,, .
Auto Wash Machine YES NO ❑ 4'�� ;
lfY�q. C, '�i'�l. 5 � \ � . l.f:•• ��,, Cir,.,, � N'�-ebE°.
Type Water Supply _ vi (A
'This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by0l .1
'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
AM
Certificate of Completion J
p --_ .— 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.
DOME COUI= HEALTH DEPARTNEUT
PERCOLATION TEST RESULTS
DATE /a -..Z b - 7 T
LOCATION l'c,Crn.�
FIIIDI14GS : HOLE t10.
3 2
2
4
5 73 T ��
6
LOT DIAGMIII
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DAVIE COMITY HEALTH DEPARTMENT V Jl
ENVIRONMENTAL HEALTH SECTIO14
P. O. BOX 57
MOCKSVILLE, N.C. 27028
(704) 634-5985
Statenent for Septic Tank Improvements Permits and/or Site Evaluations
NAME1 v. i� Z v,,eS DATE {Q -.Ala —'71
ADDRESS ';�w,ke S, t7y %$114% A PEP11IT 140. c% D
fv\oC Y•
EXPLANATION OF CHARGE 1 _F 6..QcL,
AMOUNT DUE O.A SA14ITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be completed until payment is received.
Improvements Permit(s) can not be issued until payment is received.