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DAVIE COUNTY HEALTH DEPARTMENT .S7 0U
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
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*NOTE: Issued in Compliance with G3. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules(10 NCAC 10A .1934-.1968) Permit Number
Name C� r N E v,� S�, �c�eS Date �n
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home Business Speculation
No. Bedrooms !A No. Baths _ _ No. in Family
Garbage Disposal 'YES_ ❑ NO ❑ Specifications for System:
Auto Dish Washer YES'❑ . .NO ❑
Auto Wash Machine YES-E]—NO ❑ Sk, 1 +
Type Water Supply
*This permit Void if sewage system described below isnot 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
17
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.
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION , '
*WOT-E:-.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 C__� V Date a•: 239
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Location �� 1
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 ❑
. Specifications for System: �
Auto Dish Washer YES'`❑ NO ❑ /c�<> ,y"�Q — ��-+�
Auto Wash Machine YES ❑-•> NO -❑
Type Water Supply
*This permit Void if sewage system described below i� not installed within 36 months from date of. issue.
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Ptii1�
i N,
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
� I
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.
INFORMATION FOR SEPTIC SYSTEM REPAIR PERMIT �`� \Z�'�'
PHONE NUMBER
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► DRESS a)L 1 �3 ' SUBDIVISION NAME
SUBDIVISIO_N,/ LOT
DIRECTIONS TO SITE f� (� c• ,E
A, /17
DATE SEPTIC SYSTEM INSTALLED 1
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER �>
SPECIFY PROBLEMS THAT ARE OCCURRING sZss�-� C _ a•- ��r.ap
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DATE REQUESTED - 2�_ $ INFORMATION TAKEN BY ��