116 Chunn Ln DAVIE COUNTY HEALTH DEPARTMENT L X�
• IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION o
•NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name Date ,�� f1(� N2 5892
Location �� J 1A S
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:
Auto Dish Washer. YES ❑ NO p
Auto Wash Machine YES
Type Water Supply
'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.
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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 = Date `I r v 0
"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 Z
�- v IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'NO
" 9T Issued in'Compliance With Article 11 of G.S.Chapter 130a
Sanitary Sewage Systems _ Permit'Number
Name , t �+���:�,� �J �.w �� Date - 1 `; i'J NO 5892
Location t.l h`nJ �\
(.'� �/jfI' 1"'� �, �f`S', �� r�-^i., _.•rre<?� �,�-�'s `\�O_ �).� � `.f.✓�U.`� 1 ^.�..n,-r. � r t,.J ,', �, ~'...+_c'{�'
Subdivision Name Lot No. _ Sec. or Block No.
Lot Size ' '� House Mobile Home _ Business Speculation
No. Bedrooms —1 No. Baths No. in Family 4 _
Garbage Disposal YES ❑ NO ' Specifications for System:
Auto Dish Washer YES ❑ Vp
NO ®
Auto Wash Machine AYES C} NO
` ❑ �� �, X <-
Type Water Supply
*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.
d �
NV + 4N~
Improvements permit by
*Contact a representative of the Davib-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
k�
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.
INFORMATION FOR SEPTIC SYSTEM REPAIR PERMIT
rNAME p� l�`od C h J V*N PHONE NUMBER
ADDRESS _ l _ 4aC =� `1 �J SUBDIVISION NAME
• a
SUBDIVISION LOT l
DIRECTIONS TO SITE
r \ 1
• DATE SEPTIC SYSTEM INSTALLED
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER
SPECIFY PROBLEMS THAT ARE OCCURRING
DATE REQUESTED � -1 INFORMATION TAKEN BY
0