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361 River Road Lot 24z ; 4 DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c 19c) i. 14�VSwage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number Name �i�'�9�/l/%S- ��`s'.f!�?� J��✓, _ Date //F� i9 N2 5705 Location/l�(/ /T>i9r �/ r7"ir/� — �' �, ✓ �z Subdivision Name Lot No. c>7 750 0 Sec. or Block No. Lot Size House t/ Mobile Home _ Business Speculation No. Bedrooms No. Baths No. in Family—__—_r-- Garbage amily—__—_r— .Garbage Disposal YES p NO ©' Specifications for System: Auto Dish Washer YES g NO Q ,/ � � � �� Auto Wash Machine YES NO C] Type Water Supply *This permit Void if sewage system described below is not installed within 1 Kbfilhs from date of issue. F Improvements permit by _l&/Z *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: 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. ,r. DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION ....*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 A,Jcle 13c SewagefTreatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number �ame<"' !rrl�n/.>/S !�%% i f*i Date -�� _Y�_ - N2 ; } Location Subdivision Name Lot No. ��'� Sec. or Block No. Lot Size House Mobile Home _ Business Speculation No. Bedrooms r,� No. Baths No. in Family–, Garbage Disposal YES ❑ NO 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 �6 mbnlhs from date of issue. 1 'r 1 i Improvements permit by—_('2 41/ `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: ic— Certificate of CompletionDate f�%'�� •i' "The signing of this certificate shall indicate that the system described above has been installed in compliance withs 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 (Septic Tank) Improvements Permit and Certificate of Completion (Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C) OWNER OR CONTRACTOR i +� r: l f r ' ` • DATE PERMIT LOCATION rr <_'' i°f° ,.; �!` r mak" ' +'lr ? 1690 —T` • S.R. NO. SUBDIVISION NAME cf !1c "r? ;', U LOT NO. Y" SECTION OR BLOCK NO. HOUSE [jr MOBILE HOME ❑ BUSINESS ❑ NO. BEDROOMS - NO. BATHROOMS GARBAGE DISPOSAL UNIT YES ❑ NO AUTO. DISHWASHER YES 0-- NO ❑ AUTO. WASH. MACHINE YES 0—' NO ❑ SITE SUITABLE YES ❑ NO ❑_ SIZE OF TANK gal. NITRIFICATION FIELD sq. ft. DEPTH OF STONE IN LINES: t WATER SUPPLY: Individual ❑ Public Cal IMPROVEMENTS PERMIT BY�;� House Trailer 800 Gal. 400 Sq. Ft. Two Bedroom House 800 Gal. 600 Sq. Ft. Three Bedroom House 900 Gal. 900 Sq. Ft. Four Bedroom House 1000 Gal. 1200 Sq. Ft. INSTALLED BY rj CERTIFICATE OF COMPLETION. By !�L - _ - �(�1 (8/16/73) *Construction mus comply with all o LOT AREA Date�S applicable. State and local regulations i At - K . I� DAVIE COUNTY HEALTH DEPARTMENT 3) P. 0. BOX 57 HOCKSVILLE, N. C. 27028 (704) 634-5985 Statement for Septic Tank Improvement Permits and/or Site Evaluations NAME �,;�j�; �. �,, DATE ISSUED ADDRESS d- PERMIT NO. �— Explanation of charge 1 ,, - 4 A_ / /_X 7;1 - AMOUNT DUE�4s'db SANITARIAN��,�r,I,� PLEASE REFIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.