1784 Godbey Rd (2) . + _ DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION o
*NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name ,�� ��f.�i� Date 7 ND
68,38
Location
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Subdivision Name Lot No. Sec. or Block No.
Lot Size `� �� House Mobile Home _ Business Speculation
No. Bedrooms No. Baths `' No. in Family
Garbage Disposal YES ❑ NO EV Specifications for, System:
Auto Dish Washer YES p' NO ❑
Auto Wash Ma^hine YES p-1 NO ❑
Type Water Supply \'J ---
*This permit Void if sewage syste d scribed 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.
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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 Diag m: System Installed bye
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G _I p
P
ell
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 COM LETION
'„ { •. _ . -
*NOTE:Issued in Compliance.With Article 11 of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name �� �. �., Date .. 1 _ 7 -� N2
F Location , , c .�-� L�� \ c'� !\ 10 i 6838
^N,
Subdivision Name Lot No. Sec. or Block No.
^' Lot Size 1` House Mobile Home _ Business Speculation r
No. Bedrooms No. Baths `' No. in Family
Garbage Disposal YES p NO Specifications for System: 1� " •' ;
Auto Dish Washer YES p' NO ❑
Auto Wash Ma thine YES p' NO ❑ r
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 orathe intended use change. `
j
) e
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 Diag'am: !� �f 'System Installed by
/off f
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.
I
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
WORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT
NAME S \ Jr-y PHONE NUMBER —i 9 LI 3
ADDRESS SUBDIVISION NAME
l SUBDIVISION LVOT# \
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED
NAME SYSTEM INSTALLED UNDER
SPECIFY PROBLEMS OCCURRING
DATE REQUESTED "�I g�— INFORMATION TAKEN BY C__ Es�—