P6609 Redland Rd DAVIE COUNTY HEALTH DEPARTMENT
' IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION Sd,Oo
*NOTEAssued in Compliance With Article 11 of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name ��zs . ��,,,,� ��<./<,,,,, y a z�Z Date / - /�- 9/ NO
6609
Location is - RAJ/n„,d� 11 `i11111Lr- ',_ 2{ - -d IS,<-
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home — Business Speculation
No. Bedrooms Z No. Baths I No. in Family —
Garbage Disposal YES ❑ NO 2- Specifications for System: i o 0 0 T—
Auto Dish Washer. YES ❑ NO p-
Auto Wash Ma.hine YES E[ . NO F-1 - - "X X ITuc Jc
i 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.
F
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
y '
Certificate of Completion Date 42-FI-149,1
"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 SU.00
*NOTE:1ss6ed in Compliance With Article II of G.S.Chapter 130a - --
Sanitary Sewage Systems Permit Number
��, N
i?�4 C..;, �</..,.,; �• S/ cs ., Z 7-
Name Date / Z- / i( 0
6809
61-5-
�
- Location 6 /s b�,
Subdivision Name Lot No. Sec. or Block No.
Lot Size ' House Mobile Home Business Speculation
No. Bedrooms Z. .No. Baths ( No. in Family —
Garbage Disposal YES ❑ NO p- Specifications for System: i o T--
Auto Dish Washer YES ❑ NO p-
Auto Wash Ma thine YES p 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 use change.
4
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.
Final Installation Diagram: System Installed by. r
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.
COMPLAINT FORM
DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
Date Received
Name of Complainant Received By
Address _ Telephone
Complaint
oQ
J
Person Responsi le for Complaint
Address Telep ne
Directions to Complaint
A,1vawn e- 24d'd
Date Investigated Investigated By
Complaint Justified Complaint Not Justified
Action Taken c -2 —
v�
Date ��'��-�l Environmental Health Staff Signature
(DCHD 1/85)