255 Baileys Chapel Rd .:i'.+^.. ;. .;,: +.,s.:v,...?:..a u..,,i-ti.r."•�&'��, '+'+:tC+x.vtl" c' aidr;},,. u r '.a,lp,zr r 7 . -..v, .« . .. . . -
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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 Slew—, 81ac.4we.il Date % `8`l ND 54,033
Location �-o r K Ch. 121 - Mur uti.a'n n'.�td.'S L�,•n•�1 ]�c� 1� '8, cic Ie
2 3l t(-S AA, 4,, Z7oa6
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home Business Speculation
No. Bedrooms _ No. Baths No. in F, r r
Garbage Disposal YES 1] NO p Specifications for System: b_Zli _
Auto Dish Washer YES p NO p �ao'X3X+4"R�cK
Auto Wash Machine YES p NO C]
Type Water Supply w(-It
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
tJ� �
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�V
Improvements permit b: —'rte- -,
*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 7
S 15 � O �ll.�
Certificate of Completion —4 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.
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DAVIE COU +iTY HEALTH DEPARTMENT
SII ' 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 (10NCAC 10A .1934-.1968) Permit Number
Narrle S-l,e,,e 1ac.Kwtil Date -3 ` ? NO '
5493
Location Zz P 9 C�. KcU TA r
R+ 2 $ A Z 7 o at-
Subdivision
VSubdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _� Business Speculation
No. Bedrooms _ No. Baths No. in F�
Garbage Disposal YES ❑ NO ❑ Specifications for System: �,_,i
Auto Dish Washer YES ❑ NO ❑ 2 o' t
+� X3Xrft RucK
Auto Wash Machine YES ❑ NO ❑
Type Water Supplyu
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
kL
018
L;
1 w
Improvements permit bl:-
*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
*The signing of.this certificate shall indicate that the system described above has been installed incompliance 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 S4e v-e, PHONE NUMBER
ADDRESS ^J2�• Z %wr SUBDIVISION NAME
• rt d V q�tAy�c—
SUBDIVISION LOT 0
• 'DIRECTIONS TO SITE �w1F- c�,. �- -T'. w.L• `�Q.le, Ca,Q RaD — lad' �r�-l� hvks�
w.
DATE SEPTIC SYSTEM INSTALLED uv 3d��►o
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER
SPECIFY PROBLEMS THAT ARE OCCURRING �'�%yw� aP,p;« L
.lo"A. i•S.X.- .�,ca�a.�S2 'Z�e.�—._.- .,;.�ti \a-� 1, w..,,.��-s.
DATE REQUESTED 3 INFORMATION TAKEN BY