2328 or 2344 Hwy 801S;: t� �-.,�... .. , 5.. .v.'�-v'i'13 P'-.vl'ix�'W'�{v^•-u-..�.j�. :M � .. - , 5 .-i _
DAVIE COUNTY HEALTH DEPARTMENT t� 50
�! IMPROVEMENTS PERMIT AND , CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article II of G.S. Chapter 130a
Sanitary Sewage Systems Permit Number
Name —
Location
.•. kms... .mow \ -�
Subdivision Name Lot No. Sec. or Block No.
Lot Sized ' House Mobile Home _T Business --'Speculation
No. Bedrooms :No. Baths �' No. in Family
Garbage Disposal YES, ❑ NO g Specifications for System:
Auto Dish Washer' YES ❑ NO [-
Auto Wash Ma shine YES p' NO ❑
Type Water Supply
*This permit Void if sewage lsy_stem de c ibed b� elo �s n_i tq installed within 5 years from date of issue.
This. permit is subject to revocatio If-siterp 111 or the intenpU-e-d-us hange.
)5e,
p
0 �t
Improvements permit
*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
QtJ"
,l
Date -11 ��l -�y� N2
6797
Certificate 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.
4747'.";Zd 1
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
TName C f � Date—G-1 - _ 1 ' N2
Location �.C`� �.�# .:� �. ,r, `� 9
cz-
Subdivision Name Lot No. Sec. or Block No.
Lot Size ��'`r' House t'l Mobile Home Business Speculation>
No. Bedrooms —!9_.No. Baths No. in Family — w
Garbage Disposal YES ❑ NO p- Specifications for System: i� • �� �t
Auto Dish Washer. YES p, NO [D,
Auto Wash Ma;hive YES NO ❑ O�� x y 1 a�C�
Type Water Supply
*This permit Void if sewage'sy_stem described belowls-nota stalled within 5 years from date of issue.
This.permit is subject to revocat f-site..plans or he'` iin�tended-use-change(
i
F.
Improvements permit�-
*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
—n
r -
Certificate of Completion / �'' Dated
*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', Do
WORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT
NAME �—� �� PHONE NUMBER 9% % + E o 3l
ADDRESS SUBDIVISION NAME
v1\'oc-Q
I SUBDIVISION LOT#
DIRECTIONS TO SITE
v
DATE SYSTEM INSTALLED cur•- �� �'` �� }'�-��'
NAME SYSTEM INSTALLED UNDER
SPECIFY PROBLEMS OCCURRING
DATE REQUESTED a - q INFORMATION TAKEN BY \"�