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P2295 Riverview RdDAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *No`?.I;�;:0--d in Compliance with G.S. of North Carolina Chapter 130—Article 13c. Permit Number Name '� r.'e ,�� f ,;, Date i-''"/ – f ��'� 22SS Location a Subdivision Name'--',� �/ j'r -` x `` Lot No. Sec. or Block No. Lot Size /='',/` House Mobile Home Business Speculation j) No. Bedrooms No. Baths No. in Family Garbage Disposal Auto Dish Washer Auto Wash Machine Type Water Supply YES ❑ NO [D YES El NO ❑ YES] NO i❑ Specifications for; System: h *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: I/• System Installed by Certificate of Completion �' ' L� 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 COUllM. HEALTIi DEPARMIENT PERCOLATION TEST RESULTS DATE //— _ — % NXIE LOCATION_ef FINDI.1GS : HOLE 140. CW MENTS 3 4 5 6 By: LOT DIAGRMI L DAVIE COUNTY HEALTH DEPARTMENT P. 0. BOX 57 MOCKSVILLE, N. C. 27028 (704) 634-5985 Statement for Septic Tank Improvement Permits and/or Site Evaluations NAME �;; � / /ly' DATE ISSUED ADDRESS PERMIT NO. Explanation of charge O AMOUNT DUE�,�//SANITARIAN PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.