389 Duke Whitaker Rd NZ
DAVIE COUNTY HEALTH DEPARTMENT
_IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION -.,a! (� r
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment an¢:,,Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
c �
Name 4 Date
Location \�
Subdivision Name ��� Lot No. Sec. or Block No.
Lot Size 0 House �� Mobile Home _ Business' - Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES ❑ NO _
S ecifications for .System:
Auto Dish Washer YES p' NO ❑
Auto Wash Machine YES NO .❑
/x
Type Water Supply __—
*This permit Void if sewage system described below is not installed within 36 months from date of i
h c, Q
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
C.
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.
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION a i ►
'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 r'7
Location S:�
1.2
Subdivision Name�r l `' "'� Lot No. Sec. or Block No.
Lot Size. � � _ House 1.-' Mobile Home — Business Speculation
No. Bedrooms ` No. Baths No. in Family
Garbage Disposal YES ❑ NO
Specifications for System:
Auto Dish Washer YES ❑% NO ❑ –�- _ e�� ` 1 _�!� _ \" .�
Auto Wash Machine YES [DI NO ❑
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of 'ssue--.
e Ali
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
*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
D / PHONE NUMBER $ �AUl
WA1 � U a-
AME 4 , /
ADDRESS SUBDIVISION NAME Fagg
Ald, 74A
SUBDIVISION LOT #
DIRECTIONS TO SITE
DATE SEPTIC SYSTEM INSTALLED
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER
SPECIFY PROBLEMS THAT ARE OCCURRING
..P.GCJ