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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 130
Sanitary Sewage SysteWq, Sob Cope JOW..I & Permit Number
Name 1/ l earl/ l�}�-1 Date. –� . .�,1'ti1 t ��ai..7 G G 4
Location
Subdivision Name Lot No. ^�'' Sec. ,or 8Iock.No.,
Lot Size Housey Mobile Home —T Business Speculation
No. Bedrooms No. Baths No. in Family--
Garbage
amily —Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Ma^.hine YES ❑ NO ❑
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 —! la
*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
Certificate of Completion Date 2/2:.1
'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.
to "w+. tY t* y`2a ,,. f., `l'>•�y + *' Y . 3`+a .. ;'�; . _ ;{ .s .y+w'=, ra .:F�� r r..,*+ tit . , .x .. r:,,. � � �'�;.
DAVIE COUNTY HEALTH DEPARTMENT i
r" IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION.
*NOTE: Issued in Com liance With A i lelf,of S. Chapter 130a
' —itary Sew ge Syste ° ' `°�' p/}9v' 3o �- - Pe%� It Number
�y ouv R���,�o,�aoa ,�-;� .>3������► `No�...7
- Nam _ _ �.. Date \ 224
„�- Location _
Subdivision Name Lot No. Sec. or Block l o.`
r
Lot Size House J Mobile Home _T Business Speculation
No. Bedrooms No. Baths No. in Family _
Garbage Disposal YES ❑ NO ❑ '` Specifications for System:
Auto Dish Washer YES ❑ NO ❑ y
Auto Wash Ma shine YES ❑ NO ❑ ��� �'��r /` ��
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 1:00-1:30 P.M. on day of completion. Telephone Number 704-634-5985.
Final Installation Diagram:
F
System Installed by
Certificate of CompletionDate
*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.
M
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
WORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT
NAME l PHONE NUMBER
ADDRESS SUBDIVISION NAME
SUBDIVISION LOT #
DIRECTIONS TO SITE•'�,�-
DATE SYSTEM INSTALLED //��t',✓�rv,�%
T
NAME SYSTEM INSTALLED UNDER
SPECIFY PROBLEMS OCCURRING
DATE REQUESTED'
NFORMATION TAKEN BY