270 La Quinta Drive Lot 123x •_ _ v .. a •4 .. 4 .. .... -
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION..
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c 3'
Sewage,,Trepkr�qnt andis�Qs(t Flb e 1 Q�AICAG 10A .1934-.1968) Permit Number
Name Lo
N2 545o
Location
a
Subdivision Name w ° �` �� Q"�%� Lot No, Sec. or Block No.
Lot Size Nouse- Mobile °Horne Business Speculation
No. Bedrooms > N8." Baths ZI No. in -'Family
Garbage Disposal"—••-`'YES,I.O.,.: NO ID/-
* S ecificatiorisryfor S �sfem:
P Y t 4
Auto Dish Washer YES [e 'NO ❑
Auto Wash Machine YES, ®ANO
Type Water Supply
*This permit Void if sewage system described bell is not installed within 66 months from date of issue.
i
1 � �
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. it
Final Installation Diagram: System Installed by14c44
Linc 14-2 61-)e •cy,
P, YVN
FAUL-
4 AL —
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Certificate of Completion Date —3
*The signing of this certificate shall indicate that the system describey 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, C0'U1+TY HEALTH DEPARTMENT
IMPROVEMENTS" PERMIT AND CERTIFICATE OF 'COMPLETION
6121
*INCITE-,' -issued in Compliance with G.S. of North Carolina'.,Chapter 130 Artib[6 13c
51 i5o
Location
kA
Subdivision Name Lot No. Sec. or Block No.
Lo{ Size House N1obik611ona» � �ua|neae SpeculationGarbage
No. Bedrooms N6.' Baths L No. in Family
_ l YES -- NO -_ .
Auto D�hVVaoher n�' ' '
'�" NO
Auto Wash Machine NO
Type Water Supply
*This permit Void if months from dote of issue.,
/ :v
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,
Improvement
~Contacta representative of the Davie County Health Department for final, inspection of this system between 8:30-
9:30 A.M.
:3O'9:3OA.K8. or 1:00-1:30 P.M. on day of completion. Telephone Number: 7O4 -G34 -S885.
- taatDiagram: . System —Installed -'
Li'+« \^
^.-4-2i' /~ ^��/�_
0, Y. _5,4"p»u-
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'
Certificate of Completion
Date 3
*The signing of this certificate shall indicate that the system denorbad above has been installed in compliance with
- th d nd forth in the above reQu|aUon.but shall inNO way bataken aaaguarantee that thesystemviUfunction
satisfactorily for any given period oftime.
`
� \
.
�.
,
,
Improvement
~Contacta representative of the Davie County Health Department for final, inspection of this system between 8:30-
9:30 A.M.
:3O'9:3OA.K8. or 1:00-1:30 P.M. on day of completion. Telephone Number: 7O4 -G34 -S885.
- taatDiagram: . System —Installed -'
Li'+« \^
^.-4-2i' /~ ^��/�_
0, Y. _5,4"p»u-
[ ^
'
Certificate of Completion
Date 3
*The signing of this certificate shall indicate that the system denorbad above has been installed in compliance with
- th d nd forth in the above reQu|aUon.but shall inNO way bataken aaaguarantee that thesystemviUfunction
satisfactorily for any given period oftime.
l4NFO TNNOR SEEPTIC SYSTEM REPAIR PERMIT ���� / � � �rn' "
�D NAME � e.C" 1 -10.. PRONE NUMBER
G% 9�4�
ADDRESS/� b Hdaq SUBDIVISION NAME Qd Q
SUBDIVISION LOT #
DIRECTIONS TO SITE �%L %yfQ/yt rdad /Yf%k G(Xvdva lea C70 LfOGII�
DATE SEPTIC SYSTEM INSTALLED
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER
SPECIFY PROBLEMS THAT ARE OCCURRING
n n �
DATE REQUESTED .3- ,-1 ��� INFORMATION TAKEN BY
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