791 Ridge Rd (2) a
DAVIE COUNTY HEALTH DEPARTMENT
- - IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name �� �i \�> \ Date
Location
Subdivision Name Lot No. SeNo.
Lot Size -1 House Mobile Home _ Business Speculation
No. Bedrooms - __ No. Baths ,! No. in Family _
Garbage Disposal YES.❑ NO Q. Specifications for System:
Auto Dish Washer YES ❑" NO ❑ _
Auto Wash Machine YES ❑' NO ❑ �' %� '
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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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 vl/ 2;7 ,mac<- f-
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.
1 � INFORMATION FOR SEPTIC SYSTEM REPAIR PERMIT
.( NAME e � PHONE NUMBER'rrti ,
ADDRESS ��� SUBDIVISION NAME `
d'I
SUBDIVISION LOT #
DIRECTIONS TO SITE
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DATE SEPTIC SYSTEM INSTALLED
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER
SPECIFY PROBLEMS THAT ARE OCCURRING Q yl�,.s (-A
hone
DATE REQUESTED 3-�Lf-FY INFORMATION TAKEN BY ,�