1209 Rainbow Rd (2) DAVIE COUNTY HEALTH DEPARTMENT fJ� vvt?
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name y F t`tv�'f� N Date y �7 N2 6.245
Location V'� \_� a. v P N c N �• —11
Subdivision Lot No. Sec. or Block No.
Lot Size .3 C House Mobile Home _ Business Speculation
No. Bedrooms 3 No. Baths, No. 'in`Family —
Garbage Disposal YES ❑, NO Q-
Y._
Specifications for: System:
Auto Dish Washer YES Q ` NO [6
—
Auto Wash Machine YES. 02-' NO E] x
Type Water Supply r,R `"' !Z�� _ ---
*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
2 �
_ r=_
Improvements permit by2� �^-
*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. Telepone Number: 704-634-5985.
Final Installation Diagram: Syste 5bstalled 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.
DAVIE COUNTY HEALTH DEPARTMENT
T� " IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTEAssued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name J ,t� R F C`M � N Date L� J N2
6245
l^3
Location
Subdivision Name ` Lot No. Sec. or Block No.
Lot Size -5 r— - House P Mobile Home _ Business __ Speculation
No. Bedrooms j No. Baths No. in Family J _
Garbage Disposal YES ❑ NO g- Specifications for System: 'T°
Auto Dish Washer YES ❑ rNO � .
Auto Wash Machine YES �' N0 ❑ �- bVti X 1.� �( l
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.
0� a
f
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.',br 1:00-1:30 P.M. on day of completion. Telep one Number: 704-634-5985.
Final Installation Diagram: Syste stalled by
S`
y
A
1
L
Certificate of Completion Date - l -
'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..
WORKSHEET FOR SEPTIC SYSTEM REPAIR PEERMIT
NAME \� t PHONE NUMBER }
ADDRESS \� a'� SUBDIVISION NAME
1_SUBDIVISION LOT#
DIRECTIONS TO SITE _ 1'�, 1a-(- I[^ ov—
DATE SYSTEM INSTALLED
NAME SYSTEM INSTALLED UNDER
SPECIFY PROBLEMS OCCURRING
DATE REQUESTED INFORMATION TAKEN BY