161 Random Road Lot 2ADAVIE COUNTY HEALT 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) l Permit Number
Name �.• /%S�r�i/�/, �?Y-� Date E'.j026
Location/I/� - /� J %/,• ,i�s� / r� % t'L
Subdivision Name Lot No. P� Sec. or Block No.
' Lot Size House J Mobile Home
No. Bedrooms No. Baths _�— No. in Family.
Garbage Disposal
Auto Dish Washer
Auto Wash Machine
Type Water Supply
YES ❑ NO D,
YES 4 NO ❑
YES Qj NO fl
Business Speculation
Specifications for System:
*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:
�'__ did ��•✓�
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. Ir
DAVIE COUNTY HEALTH DEPARTMENT
-4 f. 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�%nJ/r/!�//��I
Date ,G�� N� 5026
Location, �/r - /%1//i % r % i� — /" ��i �-/Z'
Subdivision Name
Lot No.
Sec. or Block No.
Lot Size
House
J Mobile Home —
Business -- Speculation
7
No. Bedro6ms =`�� No. Baths No. in Family _
Garbage Disposal YES ❑ NO p
Auto Dish Washer YES 4 NO ❑
Auto We "li Machine YES,, NO F-1Type Water Supply
Specifications for System:
f '
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
AJeul�
(�J
,/7
r
Improvements permit by �rGG
*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:
-/w
611 ir✓�
Certificate of Completion Date �7
"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.
0 SPECIFY PROBLEMS THAT ARE OCCURRING
DATE REQUESTED �� .��..�.� INFORMATION TAKEN BYl�
INFORMATION FOR
SEPTICSYSTEMREPAIR PERMIT
NAME
17aL Pa y/S
PHONE NUMBER //~ —61f/ 24`3 v
ADDRESS��/
SUBDIVISION NAME
SUBDIVISION LOT #
DIRECTIONS TO SITE `a/_5 % • /t¢i sr. do .f vs wi°"S 0&4�✓
DATE
SEPTIC SYSTEM INSTALLED
NAME
SEPTIC SYSTEM ORIGINALLY
INSTALLED UNDER
0 SPECIFY PROBLEMS THAT ARE OCCURRING
DATE REQUESTED �� .��..�.� INFORMATION TAKEN BYl�