7401 Hwy 801S t1
r DAVIE COUNTY HEALTH DEPARTMENT
-IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in�Compliance With Article I I of G.S.Chapter 130a C -
Sanitary Sewage S stems Permit Num er
NameC�x•-� n� �� Date ,
'� - N° 5832
Location=•" _
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business._— Speculation
No. Bedrooms 3 No. Baths No. in Family
Garbage Disposal YES ❑ NO pi Specifications for System: c�
Auto Dish Washer YES p3 NO ❑
Auto Wash Machine YES 'N0 El
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.
Improvements permit by ^ ~-
*Contact a representative of the Davie County Health DeRartment for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephlge Number: 704-634-5985.
Final Installation Diagram: System Installed by�Z�'�- Z^-.::te-
7�Q
Completion Date C2
Certificate •f p
*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 inCompliance With Article I I of G.S.Chapter 130a
Saa-n�itarySewage S stems Permit Num�er
-Name�' s hl �� b Date N2 5832
Location "��
('�1 d � L - _C�c� �.U�� cam`-+_- � �i-. - ,r--L• )R . ,. �
Subdivision Name Lot No. Sec. or Block No.
Lot Size L.i> y a House Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family _
Garbage Disposal YES ❑ NO pi Specifications for System:
Auto Dish Washer YES [p/ NO ❑
Auto Wash Machine YES- -N0 11
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.
o9
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. Telephgrie Number: 704-634-5985.
Final Installation Diagram: System Installed by �•
7`iF
Certificate of Completion --%�'(--1'��� 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.
` s INFORMATION FOR SEPTIC SYSTEM REPAIR PERMIT
NAME O �\s ^� �. PHONE NUMBER
ADDRESSV toff, O2 SUBDIVISION NAME
n
SUBDIVISION LOT f
DIRECTIONS TO SITE S - ..sc �
DATE SEPTIC SYSTEM INSTALLED
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER
SPECIFY PROBLEMS THAT ARE OCCURRING
DATE REQUESTED - - �;(� INFORMATION TAKEN BY