2573 Hwy 601N may. ..�Lt� t:)'-_ :L. 'k-cs ., r,.4u ..%-"" S _.✓�. vl'... . !,t. .. .r .. ..Key' -k ,u - _ ? ,...
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 �_� .,i�. �Q� �; _ Date d t.,: t 7 0 9
Location
Subdivision Name t Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business _— Speculation
No. Bedrooms r� — No. Baths — No. in Family •-�
Garbage Disposal YES ❑ NO p Specifications for System:
Auto Dish Washer' YES Ej NO x
Auto Wash Machine YES 0,,/NO ❑ ��
Type Water SupplY � ---
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
1
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 Installationi-ag am: System Installed by
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Certificate of Completion Date _5__10 F7
*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 , �, - �\ �' Date
_1
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business -- Speculation
No. Bedrooms r No. Baths No. in Family
Garbage Disposal YES ❑ NO ❑ Specifications for System: ,
Auto Dish Washer YES ❑ NO []
Auto Wash Machine YES El- NO - _ -- -
Type Water Supply , _--
'This permit Void if sewage system described below is not installed within 36 months from date of issue.
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l
Improvements permit by _� }
*Contact a representative of the Davie County Health Department for filial 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 _T gram System Installed by
f / ) Ai-
'
Certificate of Completion __� 'l 'GZ Date �c�"_IF7
*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.
W a r45� buT
y INFORMATION FOR SEPTIC SYSTEM REPAIR PERMIT b gV
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NAME /h C/, Q/-'1�Td h- PHONE NUMBER
ADDRESS ��, to �O� 3�� SUBDIVISION NAME
SUBDIVISION LOT # l
DIRECTIONS TO SITE 6d 1V . o��o� /�7�r1 -74-!7/V 1 76 d7-
DATE SEPTIC SYSTEM INSTALLED go uea r-s o I d
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER -/ )
SPECIFY PROBLEMS THAT ARE OCCURRING E'_ �OltJ • jl G R S ��/
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