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663 Cedar Grove Church Rd (3) .._ -,,,,. - ,. ..:K:;-.t*...e'..t r. *• - Y..va.-...a,r�.c a*.tw;ti 'e s -..f a .,.._..- -_., ,.. ..,... .:a.;•'k,-'",m:X":C'3 l;,F i �rl� "°'"._ia`.,:!,=..,,..-,..' . Y...r-'�-.'sP` ;... r. .rur".x.�w,h'.+,:.<<.w. z.:V. :,..,-.:, -.,. -..,,.. ....: ,.,q: 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 `z. �����_ �., ` \ '�� - Date d ��1 - `6�1 4 3 Location 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't Specifications for System: Auto Dish Washer YES E) NO Q!: p y Auto Wash Machine YES Er NO ❑ J C) x �3 1 -U. Type Water Supply *This permit Void if sewage system described below is not installed within 36 months from date of issue. cJ -- `--- © / v i i Improvements permit by ���J. *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 L� *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,.r. r ,.w... _.J. y.1. .0 i. • .. - ..._ .•.ir -rt'-- . .•. v . flr ...f .,t • w.«.. ti. .1" �\.4,' ♦,...r . .. _ - s f .ti 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 �' ,��;� �� ., .�� Date .�� - �6! .'�4 a Location Subdivision Name Lot No. Sec. or Block No. 1<,_ Lot Size _ House �� Mobile Home — Business Speculation No. Bedrooms No. Baths No. in"Family Garbage Disposal YES :p NO Specifications for System: Auto Dish Washer YES O NO Auto Wash Machine YES NOEl Type Water Supply "This permit Void if sewage system described below is not installed within 36 months from date of issue. fa `P 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 i 1 , r 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. t INFORMATION FOR SEPTIC SYSTEM REPAIR PERMIT QQ' rf NAME ??� I PHONE NUMBER 99 ADDRESS i, d D SUBDIVISION NAME SUBDIVISION LOT # DIRECTIONS TO SITE ' 61) lJ e v?ti DATE SEPTIC SYSTEM INSTALLED NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER SPECIFY PROBLEMS THAT ARE OCCURRING ilode e- DATE REQUESTED �" 7 INFORMATION TAKEN BY