267 Cana Rd (2)-ar ;oy _-l-.r_r.�vt-'.Y...i-.-�:i�-.w:vy°n+'r+.t2 r.a,�ry,.,vKS7'- m>- r. -..---w w'+R '+�'3.i'd-•v"�i .+ w�a�.y+va�r-y""'�..-''ia"si�-.-,Xc•r .�,�... .y� s- ^w .Y :+.* ,�. ;.y•
DAVIE COUNTY HEALTH DEPARTMENT #I v
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a ,[
Sar uS P age gy �� )6 I y 9 Permit„[9 TIT
r
Name _ ate N,
Location —
= Subdivision Name Lot No. Sec. or Block No.
Lot Size.76 X O House Mobile Home Business ,. Speculation
No. Bedrooms No:Baths No. in Family
Garbage Disposal"; YES�Q NO Specifioations'foicSystem a
Auto Dish Washer YES L7 NO
Auto Wash Ma^hine "YES ( NO�
Type Water Supply
'This permit Void if sewage system described below is not installed withinw5 years from date of issue.
This permit is subject to revocation if,site plans o0he intended Use change. ,
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
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.4 A-, e,4
AA
Certificate of Completion ' ' ` Date 7 `Z
•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.
Y�f S � ,c . ..,r.Y _'.may -.,,.(_ ?`S.l:,ruT ..��''••-X` ,.T(.L KI !e r'. 1 ur-i�. , e .. br..iat�d _ .t..� . k:p ..r ,:� :
DAVIE COUNTY HEALTH DEPARTMENT
= IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a
Sar�itar�Se�wage Sys\erpsPermit 61
bfr
Name \ ( \ J UU
Location —
it ' St�;'•a-" c Q C. -_
Subdivision Name Lot No. Sec. or Block No.
Lot Size House - Mobile Home — I Business Speculation
No. Bedrooms .No. Baths No. in Family _
Garbage Disposalt YES.,E] NO a Specifications fore System°` .
Auto Dish Washer YES NO ❑ 0
Auto Wash Ma shine :,,YES NO-4-1�
TypeWater 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 or4he intended use change.
IzzI
r
M ' r
LOD
i \
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.
b Installed stem
Final Installation Diagram: System y
• i
(1� L
I
J1'
Gi '
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 ENVIRONMENTAL HEALTH SECTION
TWORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT
NAME V E� 1 �s, PHONE NUMBER y op-
ADDRESS
2ADDRESS cl i X SUBDIVISION NAME
SUBDIVISION LOT#
DIRECTIONS TO SITE N PN o 4b, c
DATE SYSTEM INSTALLED
NAME SYSTEM INSTALLED UNDER
SPECIFY PROBLEMS OCCURRING
DATE REQUESTED 1 6 ` INFORMATION TAKEN BY . C -