P2475 Redland RdImprovements permit by 1
'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. 11
Final Installation Diagram: System Installed b�%�)
j
'D - 5S
Certificate of CompletionDate
'The signing of this certificate shall indicate that the system descr b'9d 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
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION'
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit
Number
Date �,I,r��.lr � � t--j,J!5 l2 ✓�`
>.
Name �;
I,
�•
Location `1 1 , . , 1-4%, It k , -i � , ;"�, � ... +% l r..t ; [
Subdivision Name Lot No. Sec. or Block No.'
Lot Size f 'Y' 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] NO ❑
f ,t - .' �; .-, t '
J- {Z6
;
Type Water Supply'
"This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by 1
'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. 11
Final Installation Diagram: System Installed b�%�)
j
'D - 5S
Certificate of CompletionDate
'The signing of this certificate shall indicate that the system descr b'9d 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
ENVIRONMENTAL HEALTH SECTION,+ ti
P. O. BOX 57
MOCSSVILLE,! N.C. 27
(704) 634=5985 ` /�,• ;` �r��-��
a. V
Statenent for Septic Tank Improvements Permits and/or Site Evaluations
NAME VCS. L,a_rf� DATE—�-
ADDRESS /c.7� ia1 _ PL 11IT INTO.
EXPLANATION OF CHARGE1��{y�
AMOLZU D ta SAIIITARIA14
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATET NT.
*NOTICE: Evaluation(s) can not be completed until paynent is received.
____ Improvements -Permit (s)_ -can -not be--issued untilpayment'isrre�ceived.— -