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P7731 Bracken Rd r A .3-D ►�C� 52/0 DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a Sanitary / Sewage S stems A Permit Number Name G�MD1f�.JDateN° 7731. Location Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home —T Business __ Industry No. Bedrooms Baths Baths _�_ No. in Family 62—_ Public Assembly Other Garbage Disposal YES ❑ NO Specifications for System: Auto Dish Washer YESNO ❑ Auto Wash Ma^hine YES [� A,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. f r 1 i 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., 1:00-1:30 P.M.or 4:30-5:00 P.M.on day of completion.Telephone Number:704-634-5985. Final Installation Diagram: ������ System Installed by _ ifti{ AI /erti icate of Completion � Date 0^' *The signing of this certificate shall indic to i hat the system described above has been installed in compliance with the standards set forth in the above regul do , but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. 3a rho DAVIE COUNTY. HEALTH DEPARTMENT . IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a Sanitary > Sewage Systems Permi t Number Name 1 � 1L�L�d�r� �•© - �( � rJCate /'�y N2 1 7 3 I , Location �" �' 'l %� ' sem ��� ��1 Subdivision Name Lot No. Sec. or Block No. Lot Size _ HouseMobile Home _ Business Industry No. Bedrooms _.No. Baths No. in Family - Public Assembly Other Garbage DisposalE]YES NO [2,"'rSpecifications for System: Auto Dish Washer YES NO ❑ _ �/ ,Q, ,� Auto Wash Ma thine YES T NO ❑ 1S—D y /►pZ�7� !� '�`'X 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. t. J { a , + 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., 1:00-1:30 P.M. or 4:30-5:00 P.M.on day of completion.Telephone Number:704-634-5985. Final Installation Diagram: 1"nSystem Installed by J ert icate of Completion Z�' Date �7� *The signing of.this certificate shall indic to at the system described above has been installed in compliance with the standards set forth in the above regul do , but shall in.NO way be taken as a guarantee that the system will function = satisfactorily for any given period of time:. DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION �J WORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT � NAME /y , ,l`J/`///7J PHONE NUMBER ? ADDRESS SUBDIVISION NAME SUBDIVISION LOT# DIRECTIONS TO SITE C.6pj /& 7 k ,z DATE SYSTEM INSTALLED z NAME SYSTEM INSTALLED UNDER SPECIFY PROBLEMS OCCURRING DATE REQUESTED ���� INFORMATION TAKEN BY