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172 Powell Rd DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 0. *NOTE:Issued in Compliance With Article II of G.S.Chapter 130a Sanitary Sewage Systems Permit Number 'Name 7U v V, Date �^ 1 N2 6 014 Location ` o<�s ��:� J v Subdivision Name.--- Lot No. Sec. or Block No. Lot Size House Mobile Home _ Business Speculation No. Bedrooms 3 No. Baths I No. in Family L) _ Garbage Disposal YES ❑ NO ©/ Specifications,Jor System: ; Auto Dish Washer YES .❑ •NO g-- Auto Wash Machine YES ANO ❑ Type Water Supply _ *This permit Void if sewage system described below is not installed within-5-years.ffrom date of issue. This permit is subject to revocation if site plans or the intended'(i`s`echange. I A / v c , • 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. 6n day of completion. Telephone Number: 704-634-5985. Final Installation.Diagram: System Installed by Al, 60vtll' Ce ' ' of Completion -�/ '[� Date "The signing of this certificate shall i the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way betaken as a guarantee that the system will function satisfactorily for any given period of time. DAVIE COUNTY HEALTH DEPARTMENT f l IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION r *NOTE Issued irj Compliance With Article II of G.S.Chapter 130a � Sanitary Sewage Systems - tt _ Permit Number Name: � �! sa � `�`. Date �-- t l '--� N2 60 14 Locationt "1 �y. _��J-=��_-__� \c3��• ►�`, �, `;J''. 71 Subdivision Name -� Lot No. Sec. or Block No. Lot Size House — Mobile Home Business __ Speculation No. Bedrooms 3—_ No. Baths No. in Family t-) Garbage Disposal YES ❑ NO p/ Specifications for System: _ Auto Dish•Washer YES ❑ NO Auto Wash Machine YES D,-NO ❑ .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-use01 Improvements permit by *Contact a representative of th Davie County Health Department for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. n day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by r _ C1F4nd1GatQJ Td Completion Date"The signing of this certifsystem 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. Vw WORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT NAME -�`� ��'L '�. PHONE NUMBER— ADDRESS UMBERADDRESS 40 '�n� SUBDIVISION NAME SUBDIVISION LOOT# DIRECTIONS TO SITE � GV d n it/e / �dG1Se lJ h DATE SYSTEM INSTALLED Zei /DS NAME SYSTEM INSTALLED UNDER / SPECIFY PROBLEMS OCCURRING �� uTS/'D� , ynbeq �e►/�,2/�� DATE REQUESTED a 9�90 INFORMATION TAKEN BY �