P2062 Milling Rdi1
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
f� Permit Number
Name 1 ; ,' �t ir` ': �� �;; i'..�%�C';:.i6 Date
206
Location -%' �/, +ri��: ���r% i «" r // �r ,- r/�
Subdivision Name Lot No. Sec. or Block No.
Lot Size / f"/( ' House Mobile Home "Business Speculation
No. Bedrooms ) No. Baths .� No. in Family
Garbage Disposal YES .❑ NO ❑ Specifications -for System:
Auto Dish Washer YES ❑ NO ❑ { rr71
Auto Wash Machine YES EI—NG,.[]
Type Water Supply
V
*This permit Void if sewage system described below is not installed within .36 months 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:
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.
P. 0. BOX 57
14OCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or ite Ev luatio s
�� / �/��
NAME �II/11/I2 t� DATE ISSUED
ADDRESS PERMIT. NO. f
�J�yz ,� j
Explanation of charge /-1'..%2,•��-.s'.%�cG'L
AMOUNT DUEq�, SANITARIAN
f .PLEASE REPdIT THE ABOVE=_APibUT�T ON 'RECEIPT OF,''ThIS STATEMENT. � `'