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2569 Milling Rd (2) DAVIE COUNTY HEALTH DEPARTMENT i IMPROVEMENTS PERMIT AND.CERTIFICATE OF COMPLETION , . 1 U *NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a Sanitary Sewage System`sPermit Number Name —T Date -5' W g2 NO r r, Location ,'c'3 >� �A ck \� \�5 v.�� N �' o Subdivision Name Lot No. Sec. or Block No. Lot Size 2� House Mobile Home._ Business Speculation No. Bedrooms No. Baths' � 1 No. in Family Garbage Disposal YES [:) NO p� Specifications for System: Auto Dish Washer. YES [E]--NO ❑ -- Auto Wash Ma.hine YES g'—NO ❑ P, 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. 1– I U ' • l 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 V) ,D T Naosw S i �� a• a A t1\ FvEa� Certificate of Completion Ca–� Date S *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. by' DAVIE COUNTY HEALTH DEPARTMENT _ IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article II of G.S.Chapter 130ar „r_,.<. Sanitary',Sewage Systems _ Permit= Number _Name -T +S M kR 1 Date• L� X12 N2 -7 _- 7 Location' - ` ` �• '.,. �( \ . �\\ .. `'.� °.'� � �h a ... r., -�>.iL"��-. •' / \ :ter'y'"C�.).: t h. i,�!� Subdivision Name Lot No. Sec. or Block No. Lot Size House ��,, Mobile Home.— Business Speculation No. Bedrooms No. Baths, Ll No. in Family �- Garbage Disposal YES EJNO p� Specifications for System': Auto Dish Washer YES E]-NO ❑ ---- Auto Wash Ma.hine YES ©-'NO ❑ C) o) 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. 4 1 J � f. s 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 .N D TT alp 'Ev�� , Certificate of Completion �� Date S *The signing.,of this certificate shall indicate that the system described above has been installed in"compliance with the standard's 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. WORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT NAME ioYY1a � f� 'e/�'� PHONE NUMBER ///"�- ADDRESS SUBDIVISION NAME SUBDIVISION LOT# DIRECTIONS TOCf SITE r DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER SPECIFY PROBLEMS OCCURRING DATE REQUESTED -7 _�`� INFORMATION TAKEN BY --�—