1323 Baltimore Rd (2)fDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name\.1\, �r� %--a nn rc„ �3 N S Date " l D ' 549 ND 5410
Location St y IX- Vl)°�.
\ 'J�-\`.ice
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Subdivision Name
Lot No. Sec. or Block No.
Lot Size House -
Mobile Home _ Business Speculation
No. Bedrooms No. Baths �?
No. in Family 4 >>
Garbage Disposal, YES p t'NO M'
Specifications for System:
1�- b�C
Auto Dish Washer YES [a/ NO O
Auto Wash Machine YES fg/ NO fl
Type Water Supply
_
*This permit Void if sewage system described below is not installed within 36 months from`date of issue.
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Improvements permit by Ql z
*Contact a representative of the Davie County He a nt for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completi T ephone umber. 704-634-5985.
Final Installation Diagram: fillt (�%� VL'
by e_ , �• ►�6�
110
-lad'
7.
Certificate of Completion `, Date Ar
*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.
INFORMATION FOR SEPTIC SYSTEM REPAIR PERMIT
NAMED '(� tJ 'tJ 1 +mac . t�,0 't� S PHONE NUMBER
ADDRESS` SUBDIVISION NAME
SUBDIVISION LOT #
DIRECTIONS TO SITE
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DATE SEPTIC SYSTEM INSTALLED ►.g�Q �.3�
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER
s
SPECIFY PROBLEMS THAT ARE OCCURRING
DATE REQUESTED ` — \--) - %,:\ INFORMATION TAKEN BY (�j _ Z� , �--