605 Buck Seaford Rd DAVIE COUNTY HEALTH DEPARTMENT
=� IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION f
'NOTE: Issued in Compliance with G.S. of North Carolina Chapter,130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .,134-.196_8) Permit Number
Name` Date - i
1A A
ion
Lo ati
Subdivision Name Lot No. Sec. or Block No.
Lot Size _ House Mobile Home _ Business Speculation
No. Bedrooms No. Baths t No. in Family .c.._�
Garbage Disposal YES ❑ NO, ❑" Specifications for System: r �'
Auto Dish Washer YES ❑fNO p'
Auto Wash Machine. YES ❑y NO ❑
Type Water Supply
'This permit Void if sewage system described below is not installed within 36 months from date of issue.
Jl
Improvements permit bye',,
*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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LA
Certificate of Completion Date ` 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 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
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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) r Permit Number.
Name r `; -=` `� - Date '� _ r c 5
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House / Mobile Home Business Speculation
No. Bedrooms _ No. Baths No. in Family 1__f
Garbage Disposal YES ❑ NO []' Specifications for System!
Auto Dish Washer YES ❑ NO
Auto Wash Machine YES Q NO ❑ 1 1✓ ' /
Type Water Supply _—
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
i
f
�L
r
/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 -
ti
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
.t :dAME PHONE NUMBER
ADDRESS ? / (D / SUBDIVISION NAME
SUBDIVISION LOT 4P
DIRE " 0 SlTO C
r
• DATE SEPTIC SYSTEM INSTALLED
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER /rd—o r/�'� �7���NE:
SPECIFY PROBLEMS THAT ARE OCCURRING J4P
DATE REQUESTED N ORMATION TAKEN BY ��