191 Norma Lane Lot 21DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
"Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name Date
Location
— oAk
Subdivision Name lei Lot No. 91 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 ❑ 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.
► vX 1
�6a
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 `�"^' 60fZWA0-Zv -
G5 e'
Certificate of Completion Date
*The signing of this certificate shall indicate that the system descri e above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way b aken 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.
Permit Number
Name. Date
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 ❑ 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.
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
y
Certificate of Completion ' ' Date ` r
'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
(SepticTank" Improvements Permit and Certificate of Completion
4� 7,
(Ground Absorption Sewage Disposal System G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR jx. VC, DATE -`PERMIT
ON
�LOCATI i'4j U
S. R. NO.
SUBDIVISION, NAME LOT NO. 0; jt' SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS
Rol
NO.. BE ROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT' YES 1:3 NO
AUTO. DISHWASHER YES 'U21' NO 13'
AUTO. WASH. MACHINE YES EB' --'NO' ❑
SITE'SUITABLE —YES NO [3
SIZE, OF TANK gal
NITRIFICATION FIELD, sq. ft.,
DEPTH OF STONE IN LINES:':
WATER SUPPLY:. Iridiv . idualPubl Public Ej
�V,!; N
IMPROVEMENTS PERMIT BY
817
House Trailer, 800 Gal. 400 Sq. Ft.
Two Bedro6m House 800 Gal. 600 S Ft
Three Bedroom,House 7
0 C . �Ga 1�. <:-90LO' Sq. t.,
Four Bedroom. House 1000 Gal'. Sq Ft.
-4
4) 0 Y
INSTALLED BY
Y_
CERTIFICATE OF COMPLETION. BY%
Date
(8/16,/73) -.*Cbnstruction must comply wit allot r applicable State and local
LOT. AREA d /;Z
ations