317 Stroud Mill Rd ;� 01 a V r�1J1�
DAVIE COUNTY HEALTH DEPARTMENT_ _ gyp; o
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) Permit Number
Name aA :2 N St 2, a v Date ' - 'Iq -,2_57 N2
Location c
Subdivision Name Lot No. Sec. or Block No.
Lot Size R.�ion House Mobile Home _ Business Speculation
No. Bedrooms No. Baths r_ No, in Family
Garbage Disposal; YES p NO pr�, Specifications for System:
, _, - r
Auto Dish Washer YES / NO ❑ M >;, �A� ,
Auto Wash Machine YES [V NO p �� ��� �;
\ `, � I
Type Water Supply -L'� h'
*This permit Void if sewage system`described,below isnot installed within 36 months from-date of issue.
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,.. -17 f
1a r
a � z
t� Improvements permit by\ —�- ��
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*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: Tglephone-Number: 704-634-5985.
Final Installation Diagram: System Installed by
Certificate of Completion Date ri
*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.
rri ri{w" f` �:fY 6yi :.:.y f:.-dc<•,.-y�....�..,..'•_ �.- �r u .;.'ti`. ::lt"6„r � i c: 4... .. r f. � .s . . .. . .. ♦ f'. .I
DAVIE COUNTY HEALTH DEPARTMENT �
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
-',NOTE: Issuek 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 � \ -P N Date ri - �)--s N2 5665
Location
!^-W a Al_
v
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 p
Specifications.,for System: - �X
Auto Dish Washer YES [Q/ NO ❑
Auto Wash Machine YES V NO p x
Type Water Supply `)J --
'This permit Void;if sewage system described,below isnot installed within 36 months from date of issue.
1A
Improvements permit
"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 F Y g
t
r
Certificate of Completiong Date ri '' �9
"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
NAME 7 fZ ny PHONE NUMBER
ADDRESS t$� ori. 3 rJ SUBDIVISION NAME
SUBDEISION LOT p
DIRECTIONS TO SITE I
-16
DATE SEPTIC SYSTEM INSTALLED _jn' ,
NAME SEPTIC SYSTEM, ORIGINALLY INSTALLED UNDER
SPECIFY PROBLEMS THAT ARE OCCURRING
DATE REQUESTED---\ J `�,� -� INFORMATION TAYi* BY �_