183 Buck Miller Rd i
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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) Permit Number
Name \, Z+y N S sz P. c:� NA Date �� cb - N2 5388
Location
Subdivision Name C!I �' v,�`I Lot No. Sec. or Block No.
Lot Size 5 b `�� ��° douse Mobile Home _ Business Speculation
No. Bedrooms D, No. Baths No:in Family
Garbage Disposal* s YES p NO p/ Specifications for System:
Auto Dish Washer YES g'"NO ❑ �� —
Auto Wash Machine YES E' NO p
Type Water Supply
*This permit Void if sewage'system described below is not installed 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 by
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rti"te of Completion C.. 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 regul ation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
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DAVIE COUNTY HEALTH DEPARTMENT L> °�
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE Issued in Compliance with.G.S. of North Carolina Chapter 130 Articles 13c
Sewage Treatment and Disposal,Rules (10 NCAC 10A :'1'934-.1968) Permit Number
Name _`�_� e.�..� �•� . `:�� <, eJ Date .. f 2� N2
Locationi'C"
uC.IC Y��I Ir le K�
Subdivision Name Lot No. Sec. or Block No.
Lot Size ` ., �' �� `� ° House Mobile Home _ Business Speculation
No. Bedrooms No. Baths �� y'` No. in Family _
Garbage Disposal YES ❑' NO Eq/ Specifications for System
Auto Dish Washer. YES NOc
Auto Wash Machine 'YES E' NO ❑
Type Water Supply _
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
C, r
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
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6
rtif,t ato of Completion `- Date '
*The signing of this certificate shall indic ite that the system described above has been installed in compliance with
the standards set forth in the above reguli ition, but shall, in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
INFORMATION FOR SEPTIC SYSTEM REPAIR PERMIT
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NAME —\-k) y ry _ .� y PHONE NUMBER
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ADDRESS � q�' �p�l �� SUBDIVISION NAME
SUBDIVISION LOT #
DIRECTIONS TO SITE
DATE SEPTIC SYSTEM INSTALLED 3S
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER
SPECIFY PROBLEMS THAT ARE OCCURRING
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DATE REQUESTED ,2 -� - �� INFORMATION TAKEN BY
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