384 Buck Seaford 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
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) a Permit Number
Name ��. �. Date .� o N2 '.378
Location
k.
Subdivision Name Lot No. Sec. or Block No.
Lot Size ' f-fouse V Mobile Home _ Business Speculation
No. Bedrooms _ No. Baths _ No. in Family v.:�. I
Garbage Disposal` YES p NO p' Specifications for System:
Auto Dish Washer YES d NO d
Auto Wash Machine YES Ef NO C] h,0
Type Water Supply
*This permit Void if sewage system describedbelow is of installe within 36 months from date of issue.
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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 byA
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.
•' -7o r a y • t �`
DAVIE COUNTY HEALTH DEPARTMW
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
s
*NOTE,'-Issued$in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules°(10 NCAC 10A .1934-.1968) Permit Number
Name`J_ -�:r = .a ` �:c) Date . -� N2 378
Location
Subdivision Name r Lot No. Sec. or Block No.
Lot Size House Y Mobile Home _ Business -- Speculation
No. Bedrooms i-� No. Baths No. in Family _
Garbage Disposal" YES °O NO Ef Specifications for System:
Auto Dish Washer YES NO ❑
Auto Wash Machine; YES [l NO p
Type Water Supply
*This permit Void if sewage system described below is of installe within 36 months from date of issue.
S
'•'r. 1 .,
Improvements permit byy-
*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
Certificate of Completion c'�� - � Date ah, 1
*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 betaken as a guarantee thatthe system will function
`-satisfactorily for any given period of time. y
a IN • N FOR SEPTIC SYSTEM REPAIR PERMIT
NAME p cL o PHONE NUMBER
ADDRESS '�'�'cl `�j0 x �� SUBDIVISION NAME
N SUBDIVISION LOT #
DIRECTIONS TO SITE
DATE SEPTIC SYSTEM INSTALLED ta9o,�
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER
SPECIFY PROBLEMS THAT ARE OCCURRING
DATE REQUESTED 1 \ �'� �� INFORMATION TAKEN BY ��':