P2447 Liberty Church RdDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION -
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name `�;`,',,-;� �,;.;�y, % > - — Date
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size
House Mobile Home — Business Speculation
No. Bedrooms No. Baths �� No. in Family
Garbage Disposal
Auto Dish Washer
Auto Wash Machine
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
YES ❑ NO ❑
YES ❑ NO ❑
YES ❑ NO ❑
Specifications for System:
Improvements permit by
*Contact a representative of the Davie County Health Department forfinal 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
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.
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
- — • Permit Number
Name '%`�;' 'i J,� J % r< < '. Date t ' / c`' 2.
Location
Subdivision Name _ Lot No. Sec. or Block No.
Lot Size House Mobile Home
No. -Bedrooms �� No. Baths No. in Family.
Garbage Disposal
Auto Dish Washer.
Auto Wash Machine
Type Water Supply
YES ❑ NO ❑
YES ❑ NO ❑
YES ❑ NO ❑
��i=cam
Business
Specifications for System:
Speculation
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by rl
*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:
0
System Installed by
r 1
Certificate of Completion ;,�f 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.
DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
t' (Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR Y" DATE r " _ PERMIT
l/If No - 3
LOCATION +� Ca h !; i Pr% /T "� D t7
S.R. NO.
SUBDIVISION NAME LOT NO.
OUSE [] ,,c r MOBILE HOME BUSINESS ❑
L House Trailer 800 Gal. AQ Sq. Ft.
NO BEDROOMS N0. BATHROOMS Two Bedroom House Gal. 600 Sq. Ft
GARBAGE DISPOSAL UNIT YES ❑ NO Three Be edroom HousGal 900 Sq. Ft.
AUTO. DISHWASHER YES NO Four Bedroom House + 1000�0Gaal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES JM NO ❑ ;"
SITE SUITABLE YES ❑ NO ❑ I
SIZE OF TANK 00 gal.
NITRIFICATION FIELD 14 00 sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑ :�%•---
IMPROVEMENTS PERMIT BY i sl i:/�'`�^ INSTALLED BYE
SECTION OR BLOCK NO.
CERTIFICATE OF COMPLETION By
(8/16/73) -01 *Construction must comp
LOT AREA t'q Yfll / �C� 4f,
Date
th all other applicable State and local regulations
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