235 Walt Wilson Rd v ` 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 Date
Location ,\ 1A , c>c. L
r. F1 I - `,
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 '❑ NO'
1A Specifications for System:
Auto Dish Washer YES,E] NO� oo I -f1
Auto Wash Machine YES ED-/ NO'❑ 90 (1- �� ��
Type Water Supply
G
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
1
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I D �
fmprovements 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
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ao
Jao
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
*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
1
Name Q Date —a' �J i? a
Location <aC �`., t;, L` �_ \ \�V
�/ - f ,_ I f"nom � ''S..•- -1•..C'�_ 1 � •.\ \ �� \�1.) '\��. ��� 1^j �f�(-�, !) -
Subdivision Name Lot No. Sec. or Block No.
Lot Size r House Mobile Home _ Business Speculation
a
No. Bedrooms L4 _ No. Baths _ _ No. in Familyrl_ _
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES ❑ NO
Auto Wash Machine YES per' NO ❑ 'Ti J ,1
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
)
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
`tom S S `n o
�Go i
t;
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.
INFORMATION FOR SEPTIC SYSTEM REPAIR PERMIT
NAME PHONE NUMBER 3 r V
ADDRESS a�. , '1\ SUBDIVISION NAME
SUBDIVISION LOT #
DIRECTIONS TO SITE
DATE SEPTIC SYSTEM INSTALLED
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER
SPECIFY PROBLEMS THAT ARE OCCURRING Ci o` �.r•- �1'�.
DATE REQUESTED '3 O - IS') INFORMATION TAKEN BY .