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• s DAVIE COUNTY REALT$ DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR S ) AA DATE - �' i?�� PERMIT
LOCATION c7l3/f/ - e- -, - n N° 689
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106v.-r- -aGV'-Ss P-4 S.R. NO. �,4Zq
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑ ,�.---
House Trailer 80 al 400 S
NO. BEDROOMS NO. BATHROOMS Two Bedroom House 800 Gal. 0 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three. Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑ -
SIZE OF TANK gal. g -aC � - c �l ^'�` c.AIA-,
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑ `�'(C'3 _ S 3 �'��
IMPROVEMENTS PERMIT BY &e,\ INSTALLED BY
CERTIFICATE OF COMPLETION
BY Date za
(8/16/73) *Construction must comply &tth all other applicable State and local regulations
LOT AREA
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- DAVIE COUNTY HEALTH DEPARTMENT
(Septic,Tank),Improyements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 Article 13C)
OWNER OR CONTRACTOR � DATE
PERMIT
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LOCATION /.'r' i? .� "!' 7: ,'� it-, r ,:'Ce P , r' a 6 8 9
r.v..c ✓5�... r % S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑ ...--
House Trailer < 800 Gal. 400 SF
t
N0. BEDROOMS , NO. BATHROOMS Two Bedroom House 800 Gal. t.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
r
IMPROVEMENTS PERMIT BY INSTALLED BY
CERTIFICATE OF COMPLETION By Date�O''��^7 fir_
(8/16/73) *Construction must compl ith all other applica-'Vle .State and local regulations
LOT AREA /� �•jr �5. J
COUNTY OF DAVIE
CERTIFICATE. OF ZONING COMPLIANCE
This is to certify that6iA z Uv' lvSo,
have fully complied with the provisions of the Davie County
Zoning Ordinance in the proposed constructions, alterations,
additions, or uses of a building or other structure located
or to be located at: Sg /__�,z
As Follows: '�C p l
l 3'
This _ ay of4z19 75
D ie County Zoning
Enforcement Officer
Phone: 634-3340
CERTIFICATE OF OCCUPANCY
This is to certify that the proposed constructions alter-
ations, additions, or used have been completed in comformity
to the Davie County ZoningOrdinance.
This � Day opl- 19
'Davie County Zoning
Enforcement Officer
Phone:- 634-3340
✓y
Jit N�1`L � �K4+AY41
MS. CONNIE L. STAFFORDt�` XtC � � E �ix# 8 TELEPHONE .
DISTRICT HEALTH DIRECTOR P. O. BOX 457 919/ 679.2252
919/ 679.8876
Vabhinville, Worth Carolina 27055
October 27, 1975
Mr. J. Alfred Miller
Route 2
Yadkinville, N. C. 27055
Dear Mr. Miller:
It has come to our attention that you installed a septic
tank system for Mrs. Gilda Robinson in Davie County and that
the, system was covered without inspection by the health depart-
ment. This is in violation of both county and state laws, and
caused delay and inconvenience to Mrs. Robinson because she could .
not get electrical service to her trailer.
You are required to supply this department with a diagram
of the system you installed for Mrs. Robinson, showing the loca-
tion in relation to the trailer and any wells in the immediate
vicinity. It will include the tank size, length of line, depth
of stone in line and be signed by you. This must be in either
the Mocksville or Yadkinville office by 5:00 p.m. Friday, October
31, 1975.
A future occurrence of this situation will result in legal
action against you and suspension of your permit to install septic
tank systems in Davie and Yadkin Counties.
Sincerely,
Charles King, Jr.
Sanitarian Supervisor
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