P2600 Pine Ridge Rd.. �. 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 . �^ t- -'- Date
r c1
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 0 --
Auto Wash Machine YES 0 NO ❑ t-
Type Water Supply , , i ! _—
`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
7
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 DEPARMENT
PERCOLATION TEST RESULTS
DATE /— /!o -fl
NAME TOsoi I/ //aeD - 41
LOCATION Piv�
FINDINGS: HOLE NO.
1 •
O ('nc�il�Mt ,v as
2
'la
3.
4.
S.
C01-2IENT5 d
-,3eoan;s4�,Qe.E
M4+•Pies _
LOT DIAGRAM=S
D� 3 6.,�9 �•,
d4 V1 K/y -�c5..:.
'At. 6 "19--
fl
(�� � Gc�9•,so
i��
DAVIE COUNTY HEALTH DEPART..MENT
EPJVIRONMENTAL HEALTH SECTION
P. 0. BOX 57
MOCKSVILLE, N.C. 27028
(704) 634-5985
Statement for Septic Tank Improvements Permits and/or Site Evaluations
NAb1E—Fig i1 ,, 41t 1t �,-
DATE
ADDRESS PERP4IT 110.
Ic 70.1,V
EXPLANATION OF CHARGE S; & -' 14J4
A14OU13T DdL 7 n' o c�)
SANITARIAN • 1 Y\ctti. ci ci
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATE:4ENT.
*NOTICE: Evaluations) can not be completed until paynent is received.
Improvements Permit(s) can not be issued until payment is received.