1292 Baltimore Rd DAVIE COUNTY HEALTH DEPARTMENT�,w� N� w 0. U-�
P IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 0'r 30
*NOTE:Issued in Compliance With Article II of G.S.Chapte oa
Sanitary Sewage Systems Ct 8 h.'6&11 � Permit Number
Name J ��z=�s.- -• r— Date t ► 1 9.0 N0 6209
Location 79 ) rJ -
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Subdivision Name h Lot No. — Sec.-.or Block No.
Lot Size �` G "'�'' Nouse ,Mobile Home — Business —_ Speculation
No. Bedrooms No. Baths No 'in Family
Garbage Disposal x 'YES `n, NO -M j ry Specifications for System:
Auto Dish Washer, YES , 1:14NO
rte , , \ � , I, :� (I _
Auto Wash Machine YES p/ 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.
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Ibp
Improvements permitr'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 S e-SnbN
�► J I !
t�
r ,
Certificate of Completion Date to
'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 11 of G.S.Chapte 30a
- Sanitary Sewage Systems rc G ('f r��G" ' Permit Number
Date .C) N2 6209
L9cation —
y S F - r^^� I s cif . rc,� _ ` \ ^N ;1`` ,�.r_o crl
Subdivision Name Lot No. - Sec. or Block No.
Lot Size ' House Mobile Home_ Business _— Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES`Cj I, NO 2— Specifications for System:
Auto Dish Washer YES Q` NO ❑ , "{
Auto Wash Machine YES p' NO-F-1
Type Water Supply ---
C / Ov
*This permit Void if sewage syste described below is not installed within 5 years from`d�te of issue.
This permit is subject to revocation if site plans or the intended use change.
------
�I,e�
Improvements perm t•,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 S!L 0 Q_
0 �
t�
Certificate of Completion, �� �� .' Date 1– l\1 'r� 0
*The signing of this•-certificate,`shall in that the system described above has beewinstalled 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
WORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT
NAME \Q h'�'" ` PHONE NUMBER
ADDRESS "x SUBDIVISION NAME
m
SUBDIVISION LOT#
DIRECTIONS TO SITE ' F R,� °� '"�` � �� \oo
s s
DATE SYSTEM INSTALLED b O s
NAME SYSTEM INSTALLED UNDER
SPECIFY PROBLEMS OCCURRINGNN
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DATE REQUESTED 11 ✓ � � r U INFORMATION TAKEN BY 'v A