P2483 Hwy 601SDAVIE COUNTY HEALTH DEPARTMENT
�- IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c
Name Date
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Location <
: C'7 0 i7 'r i t- t 1. t .
Permit Number
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Subdivision Name Lot No. Sec. or Block No.
Lot SizeHouse
Mobile Home — a --' Business Speculation
No. Bedrooms '7/
No. Baths
No. in Family
Garbage Disposal
YES ❑ NO Q
Specifications
for System:
Auto Dish Washer
YES ❑ NO p
Auto Wash Machine
YES Q 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:
ly'` BALL
31,
System Installed by ! SIE `t ' 2LI`'vb�
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Certificate of Completion Date
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*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 betaken as a guarantee that the system will function
satisfactorily for any given period of time.
4
DAVIE COUTIMY HEALTIi DEPARTM;£NT
PERCOLATION TEST RESULTS
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DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
P.O. BOX 57 ti
' MOCKSVILLE, N.C. 27028 ;
... (704) 634-5985
STATE14BIlT FOR, SEPTIC. TA14K I&PROVEMENTS PERMITS AND/OR SITE EVALUATIONS
NA11 91-t C� �b A. k J DATE
W34
ADDRESS S%2Z ktjA"-' A ;1? r PERMIT NO.
1
Trz rNG :Jl 144
EXPLANATION OF CHARGE14
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AP20UNT� Cza SANITARIAN
PLEASE REMIT THE ABOVE Ai40UNT OF 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.
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