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130 Wig St i s^ DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION - !� ; p -p *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 �\•� .;::, c,�i, Date fi '0's 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 ❑ NO JE] Specifications for System: Auto Dish Washer YES [j' NO ❑ � , Auto Wash Machine YES NO ❑ Type Water Supply r `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 w QP o, Certificatejdescribe Date 'The signing of this certificate shall indicate that tve has been installed in compliance with the standards set forth in the above regulation, but as a guarantee that the system will function satisfactorily for any given period of time. ~t .. ,� - -,:•.s;� a:-.,rw•'�.o-1'..:a.r+sys�..rS�. a t� .. :si-.,•, -.. ;r�,,y... ..- v 'a.:n�:ie.. . . � . .1- .... .Y... , .. .. '- _ ,. dt DAVIE COUNTY HEALTH DEPARTMENT �� s' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION L : p *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 : . .._� Y.?. L J c Location �...- Subdivision Name t,' „f,• ��Lot No. _ `Sec. or Block No.* Lot Size House Mobile Home — Business Speculation No. Bedrooms No. Baths No. in Family — Garbage Disposal YES ❑ NO © Specifications for System: Auto Dish Washer YES p' NO ❑ Auto Wash Machine YES p' NO ❑ Type Water Supply *This permit Void if sewage system described below is not installed within 36 months from date of issue. � r 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 w Certificate of Completion Date *The signing of this certificate shall indicate that the system describe 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. -- Ole b • �� Du' INFORMATION FOR SEPTIC SYSTEM REPAIR PERMITorn� PHONE NUMBERA)oZ NAME C.a7171/� CLQ�a } ADDRESS �Q 90 aGO� SUBDIVISION NAME SUBDIVISION LOT _# DIRECTIONS TO SITE S �I'DSS Y e Q• �� e d 5`f' Y-� D � (Td S✓ DATE SEPTIC SYSTEM INSTALLED � NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER SPECIFY PROBLEMS THAT ARE OCCURRING P� 14 DATE REQUESTED �-�/ INFORMATION TAKEN BY