P2243 Hwy 801SDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: ued inCompliance with G.S. of North Carolina Chapter 130—Article 13c.
% Permit Number
Name Date w,
Location
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Subdivision Name
Lot Size ` t- House
Lot No
Sec. or Block No
Mobile Home —t .ter Business Speculation
No. Bedrooms u .. No. Baths No. in Family
Garbage Disposal YES ❑; NO
Auto Dish Washer YES p --NO
Auto Wash Machine YES'p�,'1v0 �❑
Type Water Supply
Specifications for System: r
*This permit Void if sewage system described below is not installed within 36 months from date of issu/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.
Final Installation Diagram:
stalled by
Certificate of of Completion{�.�� Date A/
cj -
*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.
FIA
DAVIE COMITY HEALTH DEPARMIENT
PERCOLATION TEST RESULTS
DATE
LOCATION
FINDINGS: HOLE 140. CO:L^'lEJTS
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LOT DIAGRAM
4
5
6
By: "lo ZZ
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