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1965 Hwy 64EDAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION `Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c. 9 Name 11`lr,t`rl�;r L�� 1'J Date Permit Number Location (0 L� d Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home _ �'Business Speculation No. Bedrooms a No. Baths No. in Family Garbage Disposal YES ❑ NO © Specifications for System: Auto Dish Washer YES ❑ NO p ; DG) Auto Wash Machine YES p NO ❑ d' Type Water Supply '!!� x111.1! _— "This permit Void if sewage system described below is not installed within 36 months from date of issue. improvements permit by_--',�r� *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 �-�?��1'��/fes .d Certificate of Completion / i Date f *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 PERCOLATION TEST RESULTS DATE NA,,m U ►' 16 1 V� `z-�L i LOCATION FINDINGS: HOLE NO. LOT D 1. 2. 3. 4. S. 6. , 17bt1&W By: L C01,24ENTS DAVIE COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH. SECTION P.O. BOX 57 (� MOCKSVILLE, N.C. 27028 (704) 634-5985 w STATEMENT FOR SEPTIC TA14K IIIPROVEME172S PERMITS AND/OR SITE EVALUATIONS DATE 4E A ADDRESSPERMIT NO. 2q EXPLANATIOI4 OF CHARGE AMOUNT DU3ff` SANITARIAN PLEASE REMIT THE ABOVE AD40UNT OF RECEIPT OF THIS STATEMENT. *NOTICE: Evaluation(s).can not be completed until payment is received. Improvements Permit(s) cannot be issued until payment is received.