P2683 Pleasant Acre Dr3
DAVIE 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 C �,��. 1 ur,_-�L� 28�i-26�SI Date
Location A,^. ti c
Subdivision Name _
Lot No.
Sec. or Block No
Lot Size House Mobile Home — Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES 10 NO Q' Specifications for System:
Auto Dish Washer YES ❑ NO p
Auto Wash Machine YES ❑� NO i❑ Y. ,
Type Water Supply '-_-' A
"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
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*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 !���'�� f2
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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.
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System Installed by !���'�� f2
/r fr,r;�'_
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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 COUMN HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTIO14
_ _ r P.O. BOX 57
MOCKSVILLE, N.C. 27028
(704) 634-5985
STATEMIT FOR SEPTIC TANK IbTROVEMENTS PERMITS AND/OR SITE EVALUATIONS
NAME C. W , T DATE kA0Z- 'Z
ADDRESS Rvu'La. y PERMIT NO. 236)
EXPLANATIOI4 OF CHARGE
AMOUNT DUE a t> SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT OF RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be completed until payment is received.
Improvements Permit(s) can not be issued until payment is received.
0 y.+1
Rt. 4, Box 186-A
Mocksville, N. C. 27028
July 27, 1981
Davie County Health Department .
Mocksville
North Carolina
Attention: Mr. Mando
Deaf Mr. Mando:
In response to your telephone call I am requesting an extension of 30 days
from the date of this letter to alleviate the situation of the two mobile
homes on Pleasant Acres Drive.
I have informed Mr. Foster, the owner of the mobile home which is to be
moved. His problem has been the installation of county water lin e to his
_ mobile home Lite on Cherry Hill.Road. He has contacted Mr. Smith of the
Water Department and Mr. Smith has assured him they would install line by
August 1.- Mr. Foster has told us he will have mobile home moved by August
10 but we would like to have a 30 day extension incase of delay such
as inclement weather, etc.
Thank you.
Yours truly,
C. W. Tucker
June 9, 1981
Davie County Health Department:
This is to certify that within 30 days from this date I
will either remove one of the two mobile homes now located on
my property on Pleasant Acres Drive, or install the required
sanitation facilities to properly serve both.
/USC
C. W. Tucker
Sworn and subscribed to this the 9 day of June 1981.
otary Public
'` My commission expires-2�,?' g, �