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670 Rainbow Rd J ..' ', 1t •r:_r'A ,s '.r..n :t 111. t'.rn. . . ' . , . . .. . 1 .. t Q DAVIE COUNTY HEALTH DEPARTMENT l va IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION 'd,Q *NOTE:Issued in Compliance With Article II of G.S.Chapter 130a Sanitary Sewage Systte\\msPermit Number W—V4 Name 1A {`!tom 0 w f-A Date �'- a h - rl I NO . T-- � - 6506 Location `� �l a N`- 0- _ . Subdivi�ame ' ` M Lot No. Sec. or Block No. " Lot Size Lo House '� Mobile Home _T Business Speculation No. Bedrooms No. Baths No. in Family Garbage Disposal YES' ❑ NO Specifications for System: i Auto Dish Washer, YES ❑ s,., NO [ 0 ► Auto Wash Ma thine ~ YES ❑. NO ' 'Type Water Supply rAij-S)& _ *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 o Us 'e 0( eoF r . --f +t * L77--� 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 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 jF? ,ri<,;,� *NOTE Issued in Compliance With Article I I of G.S.Chapter 130a ". 'Sanitary Sewage'Systems Permit Number Name- � ��_e.� �... t�r�y, Date f N2 65,08 Location C '� ' �`� 1 �. c\\,r i: I iz — ` _ Subdivision Name " Lot No. Sec. or Block. o. Lot Size Ln-• House '' Mobile Home_ Business -- Speculation No. Bedrooms :No.rBaths _No. in Family Garbage Disposal YES E) NO [D. S ecifications for System: Auto Dish Washer YES ❑: NO ©r' 4; Auto Wash Ma^hine YES ❑. NO Cid- Type Water Supply "AI)i 'This,permit Void if sewage system described below is not installed within 75 years from date of issue. This permit is subject to revocation if site plans or the intended use change. Improvements permit by -�`� *Contact a representative of the Davie County Health Department for final inspection of` his, s stem between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number 704-634-5985. r ` Final Installation Diagram: System Installed by - f - �- ,t Certificate of Completion """ t 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. �, i 0, 60 . WORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT NAME yt^�O` N"e'l) PHONE NUMBER 9'9�'���q9 ADDRESS B'f a`s�� SUBDIVISION NAME a�dare�, i?G a 7 0 0 SUBDIVISION LOT# t DIRECTIONS TO SITErr,�vw DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER SPECIFY PROBLEMS OCCURRING DATE REQUESTED ��a.3�Y� INFORMATION TAKEN BY