P2384 Hwy 801NDAVIE COUNTY HEALTH DEPARTMENT
y IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
`Note: Issued in Compliance with G.S. of North Carolina Chapter 130 --:-Article 13c.
Permit Number
Name .'1e,� �^ ! Date
Location,,
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Subdivision Name Lot No. Sec. or Block No.
Lot Size
House Mobile Home
No. Bedrooms No. Baths
:2
No. in Family
Garbage Disposal
YES
❑
NO p -
Auto Dish Washer
YES
❑
NO ❑
Auto Wash Machine
YES
d
NO ❑
Type Water Supply
Business Speculation
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
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`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:
c„,-+om Installed by}� f�• 7i1C1”°r,
Certificate of Com letion f� CSL t�� ` Date.S -Z--7�o
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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 be taken as a guarantee that the system will function
satisfactorily for any given period of time.
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Certificate of Com letion f� CSL t�� ` Date.S -Z--7�o
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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 be taken as a guarantee that the system will function
satisfactorily for any given period of time.
DAVIE COUNTY HEALTH DEPARTMENT
t ENVIRONMEN'T'AL HEALTH SECTION
P.O. BOX 57 gv
MOCK SVILLE, N.C. 27029 S/ 7A
(704) 634-5985 - -
STATEMENT FOR SEPTIC TA14K Ii'PROVEM ITS PEMMITS AND/OR SITE EVALUATIONS -
NAME ������ DATE
ADDRESS1 j� PER141T NO.
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EXPLANATION OF CHARGE
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AMOUNT DUE e)o SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT 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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