P2560 Hwy 801S:., DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS :PERMIT AND CERTIFICATE OF COMPLETION
*Note:-lssued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.,
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: Permit -Nin er
Name C�/i�';/s Date
Location
,7' Ajo
Subdivision Name_ Lo 'No. Sec. or Block No.
Lot Sized House Mobile Home E' Business Speculation
f�
No. Bedrooms No. Baths ` No -in Family
Garbage Disposal YES p NO g.-�°- Specifications,forPSystem:
Auto Dish Washer YES p NO -g--
Auto
p Auto Wash Machine YES N p
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Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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`"fir✓• �%'e 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.
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Certificate of Completion �+� `"� Date
'The signing' of this certificate shall indicate that the system described a��e�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.
I
IV
DAVIE COUNTY HEALTH DEPARTMENT
PERCOLATION TEST RESULTS
DATE , -, 01��Z�
LOCATION
FINDINGS: HOLE NO.
1. //li 2110
2.
6.
LOT DIAGRAM
J
COIRENTS
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DAVIE COMITY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
P. 0. BOX 57
MOCKwSVILLE, N.C. 27028-
(704)
7028(704) 634-5985
Statement for Septic
NAME
ADDRESS
,EXPLANATION OF CHARGE !44
Improvements Permits and/or Site Evaluations
�u DATE
PLPJIIT 140.
A14OUiJT DUE SANITARIAN
;PLEASE REMIT THE ABOVE A14OUNT ON RECEIPT OF THIS STATEi`4ENT.
*NOTICE: Evaluation(s) can not be completed until payment is received.
Improvements Permit(s) can not be issued until payment is received.