2083 Hwy 601SDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
`Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
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Permit Number
/Ft
Name 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 YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑
! a.
Auto Wash Machine YES ❑ NO .❑ '
Type Water Supply _
*This permit Void if sewage system described below is not installed within 36 months from date of issue
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,
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:
60MAcIbe,
Cavuv s-yorit,
f..7v ems
System Installed by54A&W Gcrt'Nwz��
Date tO –
*The signing of this certificate shall indicate that tft 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_f4inction
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 ^ L t A z i ; / �`�a t,' ��i'.- Date s _ Z_' `: ,
Location �r'• �t'f r ; t' t _ , }.j , ,;::.a (r:�ti �.. f,. i �- r uI .
Subdivision Name Lot No. Sec. or Block No.
Lot Size House t~'" �f Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family f
Garbage Disposal YES ❑ NO ❑
Specifications for System:
Auto Dish Washer YES ❑ NO ❑ r ��, �, ��, c
Auto Wash Machine YES ❑ NO ❑ �~ '
Type Water Supply f ��� a.'1 r ; __ ✓ - �.. a
"This permit Void if sewage system described below is not installed within 36 months from date of issue.
(t. ► � E. �- �� �, it t r�
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t � r`•,i t C;) ;J %.� j r ::s �� i� I �. y � F � ls'C.'::,; ,.�
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Improvements permit by
Ij
"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:
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Cov�:(t�
System Installed
L�
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Certificate f Completion Date
'The signing of this certificate shall indicate that tfe 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
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR Iii N ll y' iw 0 k? DATE 9,12 01 ,7;1 PERMIT
LOCATION f rL17 :. 5
N9 1625
S.R. NO..
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS Cl
-NO. BEDROOMS C NO. BATHROOMS I
GARBAGE DISPOSAL UNIT YES ❑ NO C
AUTO. DISHWASHER. YES ❑ NO (f
AUTO. WASH. MACHINE YES ❑ NO [�
SITE SUITABLE YES, d NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: C1 C
WATER SU$PLY Individual ❑ Public ❑ ,
IMPROVEMENTS PERMIT BY
House Trailer 800 Gal.
400 Sq: Ft.
Two Bedroom House 800 Gal.
600 Sq. Ft.
Three Bedroom House 900 Gal.
900 Sq. Ft.
Four Bedroom House 1000 Gal.
1200 Sq. Ft.
INSTALLED BY
DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR- c. F ,1, t;- it4 DATE ��� '-�I f !' PERMIT
LOCATION N9 6 2 5
S.R. N0.
SUBDIVISION NAME LOT N0. SECTION OR BLOCK NO.
HOUSE MOBILE HOME E3 BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS NO. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑"" Three Bedroom House 900 Gal. 900 Sq. Ft
AUTO. DISHWASHER YES ❑ NO [3'" Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO Q'
SITE SUITABLE YES [f NO ❑
/ � j.
SIZE OF TANK gal., r s' f
NITRIFICATION FIELD sq. ft.j
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual. ❑ Public ❑
IMPROVEMENTS PERMIT BY { /s wz �� h < INSTALLED BY
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CERTIFICATE OF COMPLETION
By Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
El
'y- i1
DAVIE COUNTY HEALTH DEPARTMENT
P.'a 0. BOX 57
MOCKSVILLE, N. C. 27028
(704) 634-5985 r
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME (�, DATE ISSUED '713
ADDRESS i g PERMIT NO.
N
Explanation of charge.
AMOUNT DUE /,]:'— SANITARIANS _
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMEN