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1511 County Line Rd DAVIE COUNTY H DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a Sanitary Sewage Systems Permit Number \ A \ r G. Name � e N N`\ ..� �?�1 A'P.� Date � N_ � ~ � 5876 Location \ t IN\Z n o N \ 177 Subdivision Name Lot No. Sec- or Block No- Lot Size House V Mobile Home —��7�— Business Speculation No. Bedrooms 3 No. Baths No. in Family `fi — Garbage DisposalYES ❑ NO ©' Jt` `' f, Specifications for System: • Auto Dish WasherYES [-�;-`NO ❑ Auto Wash Machine YES NO ❑ + a y Type Water Supply --- *This permit Void if sewage system described below is not installed within 5 years from date of issue. This permitJs subject to revocation if site plans or the intended use change. U5 4 B c t � Improverr�enP by ermit b \ *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 2 'C' e Ap Certificate of Completion - Date Lt / *The signing of this certificate shall indicate that the system describe above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be aken as a guarantee that the system will function satisfactorily for any given period of time. :DAVIE COUNTY H ALA DEPARTMENT o � IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *•hfOTE:Issued in Compliance With_Article.l l of G.S.Chapter 130a Sanitary Sewage Systems Permit Number. `Name 1� Date N2 5376 Location rc.�,a �� \� _.LLL �` �,1 C� � ., �i^.. -i>U--�j1.'\ ~� •-"�,� '\��a�..:��.�.. ��c;•-r�l,r:.,y . . _ .. .>`.. :�—-,t„�.,i>: ...;.�,.�.r,a.,,.:� Subdivision Name v Lot No. Sec. or Block No. Lot Size House Mobile Home— Business ,- Speculation No. Bedrooms No. Baths No. in Family Garbage Disposal YES ❑ NO [y Specifications.:for System: Auto Dish'Washer 'YES p--'NO ❑ Auto Wash Machine , YES []---'N0, ❑ t� � C, . j `� `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 or the intended use change. Jit q Improve ents 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. Tel iphone Number: 704-634-5985. Final Installation Diagram: System Installed by G 1pd \ Certificate of Completion- Date Lf -� "The signing of this certificate shall indicate that the system describe f`above has been installed in compliance with �. the standards set forth in the above regulation, but shall in NO way be aken as a guarantee that the system will function ;';t satisfactorily for any given period of time. I � b`b INFORMATION FOR SEPTIC SYSTEM REPAIR PERMIT NAME - ���✓A�/f //Ui9�.� PHONE -NUMBER- ADDRESS QD . SID SUBDIVISION NAME wit) T 0(D SUBDIVISION LOT # DIRECTIONS TO SITE DATE SEPTIC SYSTEM INSTALLED NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER ��'h a-iOC SPECIFY PROBLEMS THAT ARE OCCURRING DATE REQUESTED �''_ �� INFORMATION TAKEN BY