181 Baity Rd?Jv ,;`,r;'y'rNrt" �p�"'.r'„'rx^v'w.`+„^`Y.��stvr�y';v.:e x.sr�yY��+eys��ct vii '�"""vj"P «cil�v1�YC VI•i"Wws+l"Fv'^ i�Y•,—�v,yf:_.,,.:T�.vF,�.*i�,"i>"r"�l ��j"�''rai+"�"z�,t►`�r:*(:�.. � '•N `. `"hrr e'`+h,��..
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With'Article 11 of G.S. Chapter 130a
Sanitary Sewage ems _ Permit Number
73 Name dM. e S `a-��`'� Date a 9)" NO 6882
Location
pj
1
Subdivision Name Lot No. Sec. or Block No.
Lot Size House ` Mobile Home Business, _— Speculation
No. Bedrooms t.No. Baths `No. in Family-
Al
Garbage Disposal, �...; . YES p s•,NO6-V' Specifications for System:
Auto DishWasher YES. M NO
Auto Wash Ma^hine YES B1 'NO�p
Type Water Supply
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject"lo revocation if site plans or the intended use change.
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. r
Final Installation Diagram: Sy tem Installed by
d= -
.:F
ZA
6 t UEN
Certificate of Completion BinDate
*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.
{
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. r
Final Installation Diagram: Sy tem Installed by
d= -
.:F
ZA
6 t UEN
Certificate of Completion BinDate
*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
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NO��Efliiludbin Compliance With Article 11 of G.S. Chapter 130a
anitary Sewage Sy,§tems.,,— Permit r
6 8
Name Date N2
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Sizes House Mobile Home Business Speculation
No. Bedrooms No. Baths No. in Family --
Garbage Disposal YES C3 NO Specifications for System:
Auto Dish Washer YES Q, NO ❑
rl ()U y
Auto Wash Ma shine YES ffL�IN(:❑
Type Water Supply
*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.
T.
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 completi 9 Telephone Number 704-634-5985.
Final Installation Diagram: '9S1tem Installed by_Cn'��
yem In,
F U F_ N
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.
WORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT
NAME cn q6s u''" PHONE NUMBER
ADDRESS � w� SUBDIVISION NAME
ac� %) .\fie
SUBDIVISION LOT#
DATE SYSTEM INSTALLED l X72
INAME SYSTEM INSTALLED UNDER
(SPECIFY PROBLEMS OCCURRING``9'
1'
DATE REQUESTED ' �' C
INFORMATION TAKEN BY �