P5852 Hickory St .� DAVIE COUNTY HEALTH DEPARTMENT ' 3 a
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION � �,
..*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage Syste Permit Number
Name�'? F r�\ e, i'�= R Date �, J 1 N2 5852
Location . D po
Subdivision Name L911�I _ Sec. or Block No:
Lot Size Cir House � Mobile Home _ Business Speculation
No. Bedrooms „No. Baths `No. in family _
Garbage Disposal YES ❑ NO per' Specifications for System: D -
Auto Dish Washer `YES.:❑ NO,"pr
Auto Wash Machine YES p' NO ❑ 1 qt �/ J ! t
Type Water Supply-.-. _
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
1-
4a 6
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-T-s
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. —'
DAVIE COUNTY HEALTH_ DEPARTMENT
..
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION `
*NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a
- Sanitary Sewage System Permit Number
.
Name +� t � =z �� �= i~ Date j, N
2 5852'
r
Location �1.: D ;`j ;�,1
Subdivision Name ( Lot-No.--- — Sec. or Block No.
Lot Size -`l-`� House L Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES [J NO E]— Specif cations for System:
Auto Dish Washer 'YES ❑ NO
,Auto Wash Machine YES p' NO ❑ i �( 3
Type Water Supply 1: t-t ---
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
y
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—T,
Certificate of Completion C• Date
'The signing of this certificate shall indicate that the system described above has been installed in compliance with
a s 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.
INFORMATION FOR SEPTIC SYSTEM REPAIR PERMIT
i4AME ...�` 'Q?'�/P_ �f'1/ �- PHONE NUMBER
ADDRESS `2_Z/-f'/ SUBDIVISION NAME -
/ SUBDIVISION LOT A
DIRECTIONS TO SITE 01J /0/,g,
dQ�d 0 lA.
- ► el 2� J-<A C'--L L-5-- 2'// o C OP-
DATE
. SEPTIC SYSTEM INSTALLED ��h q `77 )1, .
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER
SPECIFY PROBLEMS THAT ARE OCCURRING 77r— d LJ/ 4l �h
DATE REQUESTED INFORMATION TAKEN BY sjU�.CY