374 Deadmon Rd ►�T= 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 �c r� y 1-�1-}2f Date
y�� jt�
Location ]�iT' '1>�'tn;J fLD S hVuJt 6/ jl_ r";171 r Gj/r2-T ('j/*LS
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 ❑ o _
Specifications for System: jza,l c#-yp'
Auto Dish Washer YES ❑ NO ❑ ZCaO X Y 12"Auto Wash Machine YES E) NO ❑
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Ae
7 ,,
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: 7047634-5985.
Final Installation Diagram: System Installed by
i�
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
*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 �ck2�/ ,-IARC Date S7 5 - f3U9
Location ])i,4-DntrN IZPI -?'lVii. 01i1 r GjA—tT w X
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: /Z&f 144 Z-
Auto Dish Washer YES ❑ NO ❑ "
Auto Wash Machine YES ❑ NO C] 200 X h 12
Type.Water Supply C0 r
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
r /J
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
INV
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 as a guarantee that the system will function
satisfactorily for any given period of time.
DAVIE COUNTY HEALTH DEPARTMENT
•`.4. (Septil, Tank) Improvements Permit and Certificate of Completion
(Ground"Alssorptio} Sewage Disposa System G.S.''Chapte 30-Article 13C)
OWNER OR CONTRACTOR -�_` �;?/', � ,�'`��` DATES i PERMIT
Q
LOCATION ^`"/t'!�'"'' Yoa i $- Gam? _%�d'° '-G'� (r�i,+ 'fad' �1 l� . 1550
- r-
S.R. N0,
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE [L/" MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.'
NO. BEDROOMS '`:' NO. BATHROOMS �''�..� Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES. ❑ NO 2-- Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES [a'"" NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES EJ`140 ❑ f
SITE SUITABLE YES [3 NO [3
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: �L
._WATER SUPPLY: Individual ❑ Public
IMPROVEMENTS PERMIT BY INSTALLED BY
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must comply with al other applicable State and local regulations
LOT AREA
4.
Sad 1 ///S/�
n:
DAVIE COUNTY HEALTH DEPARTMENT
P . 0. BOX 57 V
MOCKSVILLE, N. C . 27028
(704) 634-5985
Statement -for Septic Tank Improvement Permits
and/or Site Evaluations
NAME. J.
DATE ISSUE
ADDRES PERMIT NO.
Explanation of charge . =
AMOUNT DUE SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF.-.THIS STATEMENT.
. i
4
1
DAVIE COUNTY HEALTH DEPARTMENT
. 1
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note.: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Date
Name ;i .0
rr U
r
Location
�•� ;1 r'.. 'U '� '�; j i, tl :5.� - l ,..r= "t' C r.. 1 L�,;,,i�._ :.� ~j _i� n C..I� 1 f 1:..,..
A .
Subdivision Name Lot No. Sec. or Block No.
Lot Size ''y :E - House 4-- Mobile Home _ Business Speculation
No. Bedrooms No. Baths z" No. in Family G'
Garbage Disposal YES p NO Specifications for System:
a.. .
Auto Dish Washer YES p- NO E)
Auto Wash Machine YES p• NO p
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
S _
,
_ t
"'•�.� .. ... .. _. "� .y �� f'�,�
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
1
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.