P5849 Mocks Church Rd DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION '
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*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name LIQ Q .��� � 'o -3)Date � " b - c1 No 5849
Location
Subdivision Name I nt Sec. or Block No.
Lot Size x House Mobile Home _ Business Speculation
..F
No. Bedrooms �No. Baths No. in Family_
Garbage Disposal YES ❑ .NO Specifications for System: 7,�>
Auto Dish Washer YES ❑ 'NO p,,-
Auto Wash Machine YES NO ❑
Type Water Supply A� _
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*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.
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Improvements permit byr=•.,�1
*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 bys�^�r ^ ?—
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16
Certificate of Completion Date _ V
'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, -0 ,0P
*lSJOTEf;j§sued in Compliance With Article 11 of G.S.Chapter 130a
=- ' San itary-S wage Systems Permit Number
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Name ' �1 �; �\ C' �: =�� � � �S Date a ` tJ CJ NO 5849
Location v
Subdivision Name - .Lot-No.- Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms No. Baths 1 No. it"Family-
Garbage
Family Garbage Disposal ------YES ❑ NO
Specifications for System: 1 c !
Auto Dish Washer YES.r-1 NO
Auto Wash Machine YES VNO ❑ LI r, y' ` •,:Y'°-
Type Water Supply LU
*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.
z i
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. 1
Final•Installation Diagram: System Installed by
F(M
k
66 '
=Ali
rcy
Certificate of Completion �s\ — Date
*The signing of this certificate shall indicate that tWsystem 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 F`
satisfactorily for any given period of time.
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'INFORMATION FOR SEPTIC SYSTEM REPAIR PERMIT
NAME PHONE NUMBER
ADDRESS D SUBDIVISION NAME --
a-,,,V1 /
SUBDIVISION LOT 1 ti
DIRECTIONS TO SITEGQ-
GY2� v .
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r
DATE SEPTIC SYSTEM INSTALLED
144?-717,
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER
SPECIFY PROBLEMS THAT ARE OCCURRING
DATE REQUESTED q�qjJ INFORMATION TAKEN BY ���