457 Liberty Church Rd Wre'1.•:.:ykiS11. W.a-1'•e::w�„a^7,'.a'+rw'+^�fy'D'*•'rw�LK_. ,.�,,...-i,* -t.e... .. :. 'ev'ikw.�vi+r-�5's•r•.+'^-rr�-•-�-
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*.NOTE:'Issued in Compliance With Article 11 of G.S.Chapter 130a
San`t�ry Sewag�Syster \ \ ` 9 , 3 c� )• Permit ,(d�t>� r
Name"" V-�4a�11 Date ^ANO- b /
Location '\ b }J ' oc.n V 1�`a , •�. r 0
Subdivision Name Lot No. Sec. or Block No.
Lot Size '� Okr> House Mobile Home _T Business Speculation
No. Bedrooms �' No. Baths No. in Family _
Garbage Disposal YES E] NO
/ Specifications for; System:
Auto Dish Washer* " YES ❑ t,NO
Auto Wash Ma:hive YES
J�NO
Type Water Supply..
'This permit Void if sewage system described below is not installed within 5 years from date of issuer.
This permit is subject to revocation if site plans or the intended use change.
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Imp ovements 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 — IA2 4• ZAN\ Ak.d
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Certificate of Completion C • '�� Date )D
*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
'WOTE:`Issued in Compliance With Article II of Q.S.Chapter 130a
SaVary�S�wage syste ��ff" �� \ � � _ ✓ _ �� Permlt,Nu��ir
Name
Date bb ttii .)
'
Location -- - -- ----- ,�- —
Subdivision Name Lot No, Sec. or Block No.
(,J`1
Lot Size House _ _ Mobile Home _�._ Business _— Speculation
No, Bedrooms No, Baths No. in Family —
Garbage Disposal YES ❑ NO ]�, Specifications for System;
Auto Dish Washer YES ❑ NO
Auto Wash Me:hine YES NO�. ' '� x
Type Water Supply
YP „—
*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. g,
•
o �
1 .
Im rovements 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 Installetion Diagram: System Installed by
IAriQS
0
Certificate of Completion C -�-' Date 1� �-
'The signing of this certificate shall indicate that the system described above has beer' 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
3
41 Jt7.
WORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT
�' 4 8
NAME Z PV•�� �� q' PHONE NUMBER 9 9
ADDRESS 14A, a �- SUBDIVISION NAME
Vo rr
SUBDIVISION LOT#
DIRECTIONS TO SITE -� CO U� N �� yT---� � g fxN`,�
DATE SYSTEM INSTALLED 70 --7 -2,
NAME SYSTEM INSTALLED UNDER
SPECIFY PROBLEMS OCCURRING
DATE REQUESTED -7 r3 INFORMATION TAKEN BY C