P2585 Merrills Lake 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 Date E
Location -
Subdivision Name Lot No.
Lot Size
No. Bedrooms
Garbage Disposal
Auto Dish Washer
Auto Wash Machine
Type Water Supply _
House
No. Baths
YES ❑ NO 0 ---
YES
4 -,YES ❑ NO fl
YES p NO -❑
Sec. or Block No.
Mobile Home _ Business Speculation
No. in Family
Specifications for System:
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
i
7-
-
. r'-
1 1
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 byi�,"�f,,, T
— f
I
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.
s.
DAVIE COUNTY HEALTH DEPARTMENT
PERCOLATION TEST RESULTS
DATE C/
N. L
LOCATION
FINDINGS: HOLE NO.
2. fieltl % ' S-
3.4/. . A� / 1 4 //- R
LOT DIAGRAM
COIR4ENT5
r Ci
By • Q�/
DAVIE COUNTY HEALTH DEPARTMENT ,
ENVIRONMENTAL HEALTH SECTION i
P. 0. BOX 57
MOCKSVILLE, N.C. 27028-
(704)
7028
(704) 634-5985
Staten tll for ep '-,T Amprovements Permits and/or Sita Ev luations
NAME �' , DATE
ADDRESS J �� PERMIT NO. �J
EXPLANATION OF CHARGE ✓y ✓ `��� 1 , �L � i
VV
AMOUNT DUE �� SANITARIAN
PLEASE REMIT THE ABOVE A14OUNT ON RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be completed until-paynent is received.
Improvements Permit(s) can not be issued until payment is received.