P2437 Turrentine Church RdI
DAVIE COUNTY HEALTH DEPARTMENT
s' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name Date
Location
Subdivision Name
Lot No.
Sec. or Block No
Lot Size House !--"`- Mobile Home _ Business Speculation
No. Bedrooms --' No. Baths / No. in Family `J
Garbage Disposal YES NO, [D--''
Specifications for System:
Auto Dish Washer YES r-�-NO. p
Auto Wash Machine YES NO
Type Water Supply.
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
__j
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 byjRo���
i" '?� S , c,J -r�71;p &aCkf�r
f
Certificate of Completion Date o_
"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 DEPARTMENT
PERCOLATION TEST RESULTS
r— c�
DATE
NATE
LOCATION
FINDINGS: HOLE NO.
LOT DIAGRMI
2.
3.
4.
S.
6.
COP 24ENTS
7j
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By:
DAVIE COUNTY HEALTH DEPARTMENT 0
ENVIRONME11TIAL HEALTH SECTION
�_.. .. �. -. P.O. BOX 57 J�
MOCKSVILLE, N.C. 27028 1 (/
(704) 634-5985
STATEMEIJT FOR SEPTIC TAN IMPROVEMENTS PEWMITSiD/OR SITE VALUAT ONS
NAZ�iE I 1 / �I{� DATE C
'
ADDRESS t PERMIT NO.
EXPLANATIOIJ OF CHARGE ./v11.��� f,/ .%1.� �,:�.�Fi/✓.�'/: s
AL40UNT DUE % SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT OF RECEIPT OF THIS STATEMENT:
*NOTICE: Evaluation(s) can not be completed until payment is received.
Irrorovements Permit(s) can not be issued until payment is received.