726 Deadmon Rd�..• -_ .-..- .-vim..-.X^.w .a-,...«.. � _..,s-;...:v.+'�v".--�.^-.-`�-+.vkJ..i.._v4�a;.-..v :'.a.. - +.. - .rr. -. > ... ..v...,. ..n .. -:J.:+.... . ,.-- �_
DAVIE COUNTY HEALTH DEPARTMENT
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 ,� v 1 J ��� �Z Date Z�' PIZ
Location �1 ) \� y, a
Subdivision Name \ Lot No. Sec. or Block No.
i
Lot Size - House Mobile Home_ Business Speculation
No. Bedrooms No. Baths _,No. in Family
Garbage Disposal YES ❑ N. it-
Specifications for System:
Auto Dish Washer YES 1771N �]
Auto Wash Machine YES [2 NY -❑
Type Water Supply
*This permit Void if sewage ystem described below is not installed within 36 months from date of issue. .
p
t
I
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.
Final Installation Diagram: System Installed bys •- aa� _
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 HEALTH DEPARTMENT
—IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 3 � '
-'`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
Date
}
Location '�L D
Subdivision game ` Lot No. Sec. or Block No.
Lot Size _ House Mobile Home _ Business __ Speculation
No. Bedrooms No. Baths l No. in Family F� _
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES El NP p
Auto Wash Machine YEJ f N ❑ ' '-; 'y
Type Water Supply
"This permit Void if sewage ystem 1scnbed below isnot installed within 36 months from date of issue.
V
4
1
r 1
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
Certificate of Completion C �-�� I'! Date �? r
'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 ;BP I,vI,y,✓CA, PHONE NUMBER
ADDRESS D k�� 9) SUBDIVISION NAME
SUBDIVISION LOT #
DIRECTIONS TO SITE -�d/S
3 ^� �.i+.►..,- .�... /2f — /L3r�wn ,Qor/—' w� �.uti- S:,a✓.�ri
04
DATE SEPTIC SYSTEM INSTALLED J r!t
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER
SPECIFY PROBLEMS THAT ARE OCCURRING
DATE REQUESTED INFORMATION TAKEN BY