139 Casa Bella Drive Lot 5I
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DAVIE COUNTY HEALTH DEPARTMENT
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IMPROVEMENTS PERMIT AND . CERTIFICATE OF COMPLETION `�
*NOTE: Issued in Compliance With Article II of G.S. Chapter 130a
Sanitary Sewage Systems Permit Number
Name Date 3 - 3 `� �' N2 6C81.
Location
1\ C.:,
Name Lo� Sec. or Block No.
Lot Size D ° x O House Mobile Home _ Business Speculation
No. Bedrooms — No. Baths No. in Family
Garbage Disposal. YES ❑ NO [y Specifications for System:
Auto Dish Washer YES ❑ NO [,�,,
Auto Wash Ma shine YES Le NO ❑
Type Water Supply y
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site'plans or the intended use change.
Improvements permit by� v�
*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 c�acr ar-
Sly
Certificate of Completion Ca��9 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.
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.'DAVIE COUNTY HEALTH DEPXRTMENT'IMPROVEMENTS PERMIT AND. CERTIFICATE OF COMPLETION'*-NOTE:'Is§u'ed in Compliance With Article 11 of G.S. Chapter 130a'Sanitary Sewage Systems Permit NumberName Date N2
, -
Location10Lot Nd. Sec. or Block No.
Lot Size
House— Mobile H
BusinessSpeculation
No. Bedrooms No.
Baths No'. in Family" --m
_-Q-__
Garbage Disposal
YES
. NO
Specifications System:-=-�for —
Auto DishWasher^`
/
NO []
Auto Wash Mo:hino
`/E8
NO
Type Water Supply
*This permit Vokjwage system described below inncdinwta|�dwdhin5ymmrofnonndetoof�nue.
This pernnitiooubiaottmrevocation ifsite plans orthe intended use change.
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Improvements permit by
^Conhuoto representative of the Davie County Health Department for final inspection of this system between 8:30' �
S:3O A.M. or 1:00'1:30 P.M. on day of completion. Telephone Number 704'634'5985.
,
Final Installation Diagram: System |no�d| _ __.ao by
`
-32Certificate ofCompletion Date
'The signing of this certificate shall indicate that the system described above has been installed in compliance with. `
the standards set forth 1nthe above regulation,but shall inNOway be taken amaguarantee that the system Will function,
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satisfactorily for any given period of time. _ �
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R INFORMATION FOR SEPTIC SYSTEMA RFiP&IR PERMIT
NAME �. v� \� '0.S p� `Q PHONE NUMBER 9 9 g' 1 5c)
ADDRESSSUBDIVISION NAME
SUBDIVISION LOT #
DIRECTIONS TO SITE
LaNCC
t
DATE SEPTIC SYSTEM INSTALLED
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER
SPECIFY PROBLEMS THAT ARE OCCURRING
DATE REQUESTED��_ , �2 INFORMATION TAKEN BY