1174 Jericho Church Rd • DAVIE COUNTY HEALTH DEPARTMENT o
IMPROVEMENTS PERMIT aAND CERTIFICATE OF COMPLETION b
*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 Number
Name \ VSs \ Date �l �j N2 5491
SLLocation ti
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 Specifications for System:
4a 4..7
Auto Dish Washer " YES-[/ NO [j"'
Auto Wash Machine YES_ V NO p
Type Water Supply c - J
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
O 4 J Q
x
r 1
,n.W
� 1
. S
K n f
' ryy
I im ro�ementq�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
r
1 00
-Yi
.__ r,'. ' Certificae'of Completio Date
*The signing of this certificate shall indicate tha the system de cribed above has been installed in compliance with
the standards set forth in the above regulation, ut shall in NO w y be taken as a guarantee that the system will function
satisfactorily for any given period of time.
r..,:a�v :-. ._ ....b.-:.y t -.'.`s..� .1�-,..'a:vT.J _-.'- is-s tii� ♦T; 'i i,! '-! \. .i,1'j A�.', 'rte c E{ - .f w. -.-..!i-i': ... sf Y.:-:.4 s. . ,e,._E..- ...\{J�a (�, t_ s vv
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT SAND CERTIFICATE OF COMPLETION o
� a
--NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13&
` 'Sewage Treatment and Disposal Rules,(10 NCAC 10A .1934-.1968) Permit Number
Name _ v\� Q c�� Date - �-f1 �` _1 N2 5401,
Location
W
Subdivision Name Lot No. Sec. or Block No.
Lot Size k7'e House V Mobile Home _ Business Speculation
No. Bedrooms �� No. Baths - No. in Family
Garbage Disposal YES E) NO [p/ Specifications for System:
Auto Dish Washer _"" YES,p/ NO -
Auto Wash Machine YES.W NO fl b x
Type Water Supply -- ��
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
• i `
PU !� 0 I '�' t• .. Ir
I
J /
- 1`mp'roJ6ent permitby, f-
"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 �- �
i
_ r
0�
r
ew L pr#ifica of Completio Date
"The signing of this certificate shall indicate tha the system de cribed above has,'been installed, in compliance with
the standards set forth in the above regulation, ut shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time. I
INFORMATION FOR SEPTIC SYSTEM REPAIR PERMIT 0
NAME �j9 j/� (Jl ��� PHONE NUMBER
ADDRESS /C jl SUBDIVISION NAME
• 4ac� 1�`l��r��,,j
SUBDIVISION LOT
DIRECTIONS TO
1
f
DATE SEPTIC SYSTEM INSTALLED
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER
SPECIFY PROBLEMS THAT ARE OCCURRING
DATE REQUESTED 7j 2�6 - $� INFORMATION TAKEN By