5062 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.
Name
Location
Subdivision Name
Lot Size Ac-
House
No. Bedrooms
No.
Baths
Garbage Disposal
YES
❑ NO F
Auto Dish Washer
YES
❑ NO 0
Auto Wash Machine
YES
Q NO C]
Type Water Supply
Z'�'
Date f
J
Lot No.
Permit Number
.,96
Sec. or Block No.
Mobile Home — G-, Business __ Speculation
No. in Family
Specifications for System:
*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 ✓'/ c'�
*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 J-1- AL w`01�5
5
Certificate of Comple
*The signing of this certificate shall indicate that the system
the standards set forth in the above regulation, but shall in NC
satisfactorily for any given period of time.
lance with
,ill function
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DAVIE COUNTY HEALTH DEPARTYX14T � r�
ENVIRONMENTAL HEALTH SECTION \
P. 0. BOX 57
MOCKSVILLE, N.Ci 27028
(704) 634-5985
Statement for Septic Tank Improvements Permits and/or Site Evaluations
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DATE I
IZT .S" 2S9
ADDRESS PERMIT 140. .
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EXPLANATION OF CHARGE
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SAIIITARIA14 ` .
PLEASE RFZ1IT THE ABOVE AMOUNT ON RECEIPT OF THIS STATMIENT.
*NOTICE: Evaluation(s) can not be completed until payment is received.
Improvements Permit(s) can not be issued until payment is received.