P3827 Hwy 801S2:crID
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND, CERTIFICATE OF COMPLETION 00 S
*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 �� +4. c� Date.N 2 3827
J
Location. ; _.�-_"affi' ;i'✓/ .?.•' �'' ;�,,..,x r `�_�.�: %.s
Subdivision Name [3' Lot No. - Sec. or Block No.
Lot Size House Mobile Home _ Business.__ Speculation
No.. Bedrooms `�— No. Baths 4:2 No. in Family
Garbage Disposal YES ❑ NO ❑ Specifications for. Syste
Auto Dish Washer YES ❑ NO .Q
,Auto Wash Machine YES ❑ NO ❑
d ,
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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.
Final. Installation Diagram: System Installed by �(a Cor na , e r
Certificate of Completion ate efti
*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.
2 —u
- DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Cafolina Chapter 130 Article 13c
Sewage Treatment and Disposal- Rules, (10 NCAC 10A .1934-.1968)' - Permit Number
Name l".�_ 1 Date
N1'2' �
Location
Subdivision Name Lot No. - Sec. or Block No.
Lot Size House ! Mobile Home _ Business _— Speculation
No. Bedrooms No. Baths i No. in Family _
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑ j
Auto Wash Machine YES ❑ NO ❑
Type Water Supply _— i; }. 't;1,J
'This permit Void if sewage system described below is not installed within 36 months from date of issue.
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.
Final Installation Diagram: System Installed by
I r
1 ,
Certificate of Completion / �`*' (Date f ��
��
*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.
a
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms ��i+ Date � /Fpo
This permit is granted to ( for the installati n of a eptic tank
at the residence of .,, e T ake < Address �_� /vqa Fio s
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capaacity Gal. 9d*
Manufacturer's Name Address 7.
No of lines_ width Total Length t 36 ft . No. of Scl. Ft. _ _oY
Type of filter material ( % Total tons used /S. / O
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house 900 900
No one shall install a septic tank in Davie County without a permit from the Health
Officer or his agent.
Date of final approval Signed: _
Sanitarian
I hereby certify that the above septic tank has been installed according to
sp cifications. ���
°Vyr✓�, 9/,Signed: �,E.Gce
" �° Septic TdA Con ractor
Note: �ake sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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