P2665 Midway StDAVIE 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 • " w `b' £
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size :'!"' House �'�y^ Mobile Home _" Business —_ Speculation
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No. Bedrooms - No. Baths No. in Family
Garbage Disposal YES p NO Ej-- Specifications for System:
Auto Dish Washer YES p NO p �<
Auto Wash Machine YES El NO ♦] ,
Type Water Supply
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*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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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 C'� , -0
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Certificate of Completion `' l�'1 %+ Date 7
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*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 DEPART?4ENT
PERCOLATION TEST RESULTS
DATE.
I Y
LOCATION /"ell
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FINDINGS:
HOLE NO.
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7 S�
"'T DIAGRAPY
CO',27,ENNTS
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By:
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DAVIE COLT,\M HEALTH DEPARTMENT
• ENVIRONMENTAL HEALTH SECTION 4 V
P.O. BOX 57 SIX
MOCKSVILLE, N.C. 27028
(704) 634-5985
STATEMENT FOR SEPTIC TANK IDTROVEMENTS PERMITS AND/OR SITE EVALUATIONS
NAME ir✓i� C !/+��2 /�l%C� DATE �JJO
ADDRESS .�•�f' PERMIT NO.
EXPLANATION OF CHARGE
OO
AMOUNT DUI;
SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT OF RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be completed until payment is received.
Ismrovements Permit(s) can not be issued until payment is received.