692 Beauchamp Rd (2)DAVIE COUNTY HEALTH DEPARTMENT C -A. C) 0
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
6 8
Name A� 2- 0\ IN S, 157\ 10 S Date N2 56
Location
Subdivision Name Lot No. �. o No.
Lot Size G House Mobile Home Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES fg/ NO 0
Specifications for System:
Auto Dish Washer, YES
Auto Wash Machine' YES NO C]
13
Type Water Supply
*This permit Void if sewage -system described below is not inst Ilei withinA6 Tnth� from date of issue.
%4
GGA
"b
4.
L/
L
Improvements permit by
*Contact a representative of the Davie County Health Department for fi 6'ai 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:,,, -
Cd rtificate 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.
-aktg';`ty"nle,8 �rrr: a+.it,+..a.._y;.r'; aux �*,�s.«:.sw.: �., t:.i t:T •Y; .w .�� ^` ;.i'w,e:aa s.«r.'d.Y r:t 'Y a :;p' ° r c ai-�. i .. .. ... .a. �... - ..
.tl._�` � tV�;yaak;w-„ :. s. a •,.,r.wy,,S ,^ '...:. :`F�k'r.<,�.:,,.hd r_ a.:::
p0
DAVIE COUNTY H@WLTH DEPARTMENT
l = (IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued i ` Compliance with G.S. of North Carolina Chapter 130 Article 13c �I
_T Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) ' Permit Nlrlirnb@r
``Name A Q GAC' o �^ vT r� Date `-F r �h �7 N2 5668
°.
`�'�t�
Location __ �- �-c� �1 t> <�
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES 5�/NO p Specifications for System:
Auto Dish Washer YES
Auto Wash Machine YES E/ NO C] r
Type Water Supply
"This permit Void if sewage system described below is not instLIle6 months from date of issue.
p
L/
FL,
Improvements permit by
*Contact a representative of the Davie County Health Department for fir tinspection 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 InstallatiQq Di g am fit^ .J,. _ ;'�% Systgm stalled y
vl, =
0
6
Certificate of Completion ` Date` ` y
"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. /r
' INFORMATION FOR SEPTIC' SYSTEM REPAIR, PERMIT
NAME PHONE NUMBER
ADDRESS SUBDIVISION NAME
SUBDIVISION LOT A
DIRECTIONS TO SITE Q
f
t
DATE SEPTIC SYSTEM INSTALLED AU
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER
SPECIFY PROBLEMS THAT ARE OCCURRING
DATE REQUESTED / gff7 / INFORMATION TAKEN BY _�