P2577 Laird RdDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
1 Permit Number
Name
��' ,, °`� '� � '— Date
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home Business Speculation
No, Bedrooms No. Baths 1 No. in Family
Garbage Disposal YES ❑ NO [ Specifications for System:
Auto Dish Washer YES ❑ NO ❑
r
Auto Wash Machine YES ❑ NO ❑
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
1
s
1
f �
s
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: System Installed by
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 COUNTY HEALTH DEPARTMENT
PERCOLATION TEST RESULTS
DATE ;�?
NAME
LOCATION
FINDINGS:
lay 2. Y -Y
1 S a 3.
4.
HOLE NO.
,�/ S `X,6/e 6.
COP,1ENTS
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DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOk 57
MOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
andpap-�
Evaluations J�
NAME`�/
DATE ISSUED i'GY�
ADDRESS
Explanation of charge
r
PERMIT NO.
�y {
`A140UNT DUE SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.