P2399 Pineville RdDAVIE COUNTY HEALTH DEPARTMENT
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V IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
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Nnhe: |oouod in Compliance with G.S.of North Carolina �hopb�r130-_Ar iu|a 13o�
-- Permit Number
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Name. Location
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 NO Specifications for System:
Auto Dish Washer YES NO
Auto Wash Machine YES E] NO F-l
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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Improvements permit bv '
*Contact o 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:
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System Installed by
Certificate of Completion Date
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'The signing of this certificate shall indicate that the system doourbed'abova heo|od in compliance with1heobandavdooetfo�hintheobuvevegu|odion.butohoUinNOwaybobekanooaguananb»ethattheoyotemviUfunction
satisfactorily for anygiven period of time.
DAVIE COUYN HEALTH DEPARTMENT _.._... _
JN "' ENVIRONMENTAL HEALTH SECTION _
P 0 BOX 57
MOCKSVILLE. N.C. 27028
(704) 634-5985
STATEMIT FOR SEPTIC TANK IMPROVEMENTSPE&MITS AND/OR SITE EVALUATIONS
NAPS DATE
ADDRESS "" PERMIT NO.c/s�
EXPLANA
AMOUNT DUEa4V�9 SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT OF RECEIPT OF THIS STATEMEIJT.
*NOTICE: Evaluation(s) can not be completed until payment is received.
Irmrovements Permit(s) can not be issued until payment is received:
DAVIE COUNTY HEALTH DEPARTMENT
PERCOLATION TEST RESULTS
DATE �S
NA14E &I
LOCATION --
FINDINGS: HOLE NO.
3.
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By:
LOT DIAGRA14
C01-24ENTS
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