1198 Cana Rd (2) ,'� i r'nw'r„ �i+;K i - ,E' 'a^F .N s ,t, Wr.r:_s.,. r Rr. •! + -. v .,w-a. ..-.ln'. .
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- DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION 3 A f) 5
*NOTE:'Issued in Compl ance With Article_•II of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name ° ss, p. \_ P %N Date S - �- N2 6789-
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Sizes House Mobile Home _T Busirfess Speculation
No. BedroomsTom\:N:6' aths No. in Family i —
Garbage Disposal, YE yp NO � Specifications for-,System:
Auto Dish Washer YES ❑ NO [q'
Auto Wash Ma:hine YES C9- NO ❑
15 X 3xI �
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.
�.Y.4
+` Y
1->' a use
J
5-a
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 Diageam: System Installed by -A R
14 -S �
Q
� p
Certificate of Co etion ` Date
'The signing of this certificate shall indicate th ystem described above has been installed in compliance with
the standards set forth in the on, 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 \16 `,r U, a 0
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION a q
*NOT.E:Issujdd in Compliance With Article II of-9
.S.Chapter 130a
Sanitary Sewage Systems Permit'
-Number`
Naml e Date " 7 2 �' N2 ,16769---
(j
Location ��'C > c�a! J
•V'�� \� fi.� � '�:Ss?. \L ;\ , t ..)c..�.\.)-'ast �•^`�*n �7 "Sl.CY� t� t
Subdivision Name Lot No. Sec. or Block No.
��
Lot Size House Mobile Home Busiress Speculation
No. Bedrooms C% N6.,Yaths _No. in Family _
Garbage Disposal YES'p NO E'''
Specifications for System: Y> bx
Auto Dish Washer YES ❑ NO
Auto Wash Ma;hine YES p NO ❑ / �
Type Water Supply
'This permit Void if sewage system described befow is not,installed within 5 years from date of issue.
This permit is subject to revocation if site plans.or-the..intended use change.
£
f
U
t _ ,
,
Improvements permit by
'Contact a representative otthe 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.
7
Final Installation Diagram: System Installed by
14
< .
,f
Certificate of Com etion Date
'The signing of this certificate shall indicate that lh; s�ystem described above has been installed in compliance with"kms..
the standards set forth in the above-rtrpl io, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time. "`
l/ .b& LHfcre- 4P?6"blc) Ll� .5kozO (oou- dr•U7,t)-4.
WORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIgT p
NAME- OSSc7 - PHONE NUMBER
ADDRESS �¢ �L- Z� SUBDIVISION NAME
_��ejs SV1 �le, /✓G �fD��
fI
SUBDIVISIONLLOT# /
DIRECTIONS TO SITE ! $fi hd uSe On le-4
DATE SYSTEM INSTALLED
NAME SYSTEM INSTALLED UNDER `d SSS
SPECIFY PROBLEMS OCCURRING �V
DATE REQUESTED `� `�-�� INFORMATION- TAKEN BY ��