1031 Yadkin Valley Rd ..,,
R DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION V
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules,(10 p Q10A .1934-.1968) Permit Number
Name to ZD' f' A 9 3 0
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES p NO Specifications for System:
Auto Dish Washer YES NO
Auto Wash Machine YES (� NO -p
Type Water Supply _—
`This permit Void if sewage system described below is not installed within 36 months from date of issue.
a �
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
�5
Certificate of Completion Date 4�
'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
--
-NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c �J
Sewage Treatment and Disposal Rules (10 NCA 10A .1934-.1968) Permit Number
d
e
Name `,�- : .-;r ,- ;fi ---Qaf / s oYi
; 1
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House ��1'� Mobile Home _ Business -- Speculation
No. Bedrooms No. Baths ! No. in Family
Garbage Disposal YES ❑ NO p-' 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.
� l
/ t
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 - "�'� � `` ��
Certificate of CompletionDate
"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.
INFORMATION FOR SEPTIC SYSTEM REPAIR PERMIT
NAME l� PHONE NUMBER Cl 9
�u r�cr�. r c.q N�.,
ADDRESS T+. L SUBDIVISION NAME
SUBDIVISION LOT #
DIRECTIONS TO SITE FA 4 o l - T.Ta+ V oal f:, re
k
���-�.�. v a�l�� oars - 3to - l,.ti►�
DATE SEPTIC SYSTEM INSTALLED
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER
SPECIFY PROBLEMS THAT ARE OCCURRING
DATE REQUESTED INFORMATION TAKEN BY �y� .