P2197 Jack Booe RdDAVIE COUNTY HEALTH DEPARTMENT a
--:-- IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
`Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
/ / Perm!U Number
Name 'f r/ ', i// �A Date / / /, i'i' 2.� 97
Location r r /ice r lr�/J' i �r'%, , rte;;' f�%lei/ice' �.�'�l.J/'. rJlJ ✓
Subdivision Name _ -' Lot No. Sec. or Block No.
i
Lot Size 2 /% House Mobile Home �-�'-� Business - Speculation
No. Bedrooms No. Baths f No. in Family r
Garbage Disposal YES p NO p
Specifications for System:
Auto Dish Washer YES 0 NO
Auto Wash Machine YES Q'NO p S1,�� „�'�' =,-f;! Ta. K
Type Water Supply _—
*This permit Void if sewage sy:
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:
0
System Installed by�^�
c_
1 Certificate/of Completion Date
"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 COUIM HEALTH DEPARTNEUT
PERCOLATION TEST RESULTS
LOCATION
FINDINGS: HOLE NO. COtMENTS /
LOT DIAGM
2
3
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,.K CC -
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DAVIE COUNTY HEALTH DEPARTMENT L
1
P. 0. BOX 57
MOCKSVILLE, N. C. 27028 kl
(7 04) 634-5985 �J
Statement for Septic Tank Improvement Permits
and/r Site Evaluations
NAME i� C DATE ISSUED
ADDRESS ,f( � ( iiY ,� / PERMIT NO. [iY/
Explanation of charge
49
Cr
AMOUNT DUE_ SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.