5116 Hwy 158DAVIE COUNTY HEALTH DEPARTMENT
� IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article II of G.S. Chapter 130a ' 3�
Sanitary Sewage Systems Permit Number
Name XS
Location
/�E 1:7t, �:-- -
_ Date - 11 U N° 5893
m Name Lot No.
Sec. or Block No
,t
Lot Size House Mobile Home _ Business 1*, Speculation
No. Bedrooms_ No. Baths No. in Family_
Garbage Disposal e YES ❑ NO [2�
" Specifications'for System:
Auto Dish Washer YES p NO
Auto Wash Machine YES NO ❑ b O
Type Water Supply
n
*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 tie 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 b a N ZTZ;, R
I �,-tJ P N
F -1 Fv'Q N
.Certificate of Completion
\ Date 3 � 6 9 0
*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
*NOTE Issued in Compliance With Article II of G.S. Chapter 130a
Sanitary Sewage Systems Permit Number
-
Name'< <<� ��� .,s Date___2 N2 5383
Location -.- \ N�f -)
`
--Subdivision Name Lot No. Sec. or Block No.
Lot Size ,. °a House Mobile Home — Business Speculation
No. Bedrooms No. Baths No. in Family _—
Garbage Disposal YES ❑ NO ❑,
Specifications for System:.
Auto Dish Washer YES ❑ NO p�
Auto Wash Machine YES V NO ❑ p p l ��i t ' '.'
. 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.
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;00-1:30P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram:
System Installed by �b o
j � �► UPN
`1' o o ►
Certificate of Completion Date a 0
"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
NAME l"E Agu l)-,', PHONE NUMBER
ADDRESS ��pxi /�' SUBDIVISION NAME
A44 . /i% -14 06
SUBDIVISION LOT �l
DIRECTIONS TO SITE 21d
DATE SEPTIC SYSTEM INSTALLED S� ►�,el� U eA�S
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER �A!✓,� y ��OIUN
SPECIFY PROBLEMS THAT ARE OCCURRING /` -zz ! / / /' hg- c�
DATE REQUESTED 5 /� - %0 INFORMATION TAKEN BY �,�