924 or 980 Main Church RdDAViE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name �� i�',.� � ' / �',�<' /, ;�1 :' r • s.� Date �� 2 i'
Location
Subdivision Name Lot No. Sec. or Block No
Lot Size House Mobile Home --Z-------Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal
Auto Dish Washer
Auto Wash Machine
Type Water Supply
YES ❑ NOt❑
YES ❑ NO p
YES [Er NO ,❑
�.;t i
Specifications for System:
J�
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
i0
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 n 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 DEPARTM14T
PERCOLATION TEST RESULTS
DATE '
LOCATION
FIIIDI14GS: ,o HOLE 110. %
COMMITS
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DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57 IA
MOCKSVILLE, N. C. 27023
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAPdE DATE ISSUED��
ADDRESS
Explana
PERMIT NO.
AMOUNT DUE SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.