197 Vogler Rd DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
Sanitary Sewage Systems Permit. Number
Name Q,rm t.VN o o DateN_
0
6269
Location \,\'Y
-, t c�i i - 'n h�
k------ .7� Sr�
Subdivision Name Lot No. Sec. or Block No.
Lot Size cn gj-� House Mobile Home _ Business Speculation
No. Bedrooms 3 `'No. Baths 1 No. in Family�—
Garbage Disposal YES ❑ NO �y
Specifications for System: t,}
Auto Dish Washer , YES ❑ .,NO [� J�,.._
Auto Wash Machine .YES ❑ NO pi
y
Type Water Supply L11..Z ---
This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subjecfto revocation if site plans or the intended use change.
i,-
i
ti
F w �
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
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.
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DAVIE COUNTY HEALTH DEPARTMENTQ)
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a
p Sanitary Sewage Systems Permit Number
r' _ ` -? 6269
Name �',' t��',.s', �+ QA � �' Date -= { a No
Location 12K -� , '; a v Q
VA
Subdivision Name Lot No. Sec. or Block No.
Lot Size y ncn %b House I Mobile Home _ Business Speculation
No. Bedrooms 3 No. Baths No.-in-'-Family _
Garbage Disposal YES ❑ NO l�K Specifications for System:
Auto Dish Washer , YES ❑ NO a �-p�
-Auto Wash Machine YES ❑ NO, [sy l J
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.
i
ti
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
1
I
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.
WORK TET FOR SEPTIC SYSTEM REPAIR PERMIT
NAME PHONE NUMBER- 99% -
ADDRESS 113 SUBDIVISION NAME
SUBDIVISION LOT# 1
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED
NAME SYSTEM INSTALLED UNDER
SPECIFY PROBLEMS OCCURRING
L
DATE REQUESTED - - �� INFORMATION TAKEN BY ��