P2530 Hwy 601NV' -`1 ;'
DAVIE 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 Date
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
Specifications for System:
Auto Dish Washer YES E] NO FL]
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.
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
led.by
C 0 C (Z"F g-;
Certificateof Completion 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.
V2 DAVIE COMITY HEALTH DEPARMIEUT
3 V PERCOLATION TEST RESULTS
DATE e' ZC �y
LOCATIO:1
FINDINGS: HOLE 110. COMMENTS FAA fL,c, k( 6an77
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By:
LOT DIAGIUM
TRivE
DAVIE COMITY HEALTH DEPARTMENT v
ENVIRONMENTAL HEALTH SECTION ��
P. 0. BOX 57
MOC&SVILLE, N.C. 27028
CA
(704) 634-5985
Statement for Septic Tank Improvements Permits and/or Site Evaluations
PIAb1Ey i lir-!JC.. c DATE
RP�IT Id0.
ADDRESS��%�_ f PE�?j�
dc
EXPLANATION OF CHARGE
AIMLED
JT Q SANITARI ..
PLEASE- PMMIIT T ,I;; ABOVE Ai41OUNT ON RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be completed until payment is received.
Improvenments Permit(s) can not be issued until payment is received.