177 Call Rd DAVIE COUNTY HE LTH DEPARTMENT
IMPROVEMENTS PERMIT AND ERTI -ATE OF COMPLETION
`NOTE: Issued•in Compliance with G.S. of North Carolina apter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC OA .1934-.1968) Permit Number
Name �n'o,R\`�S cs�� D to K _ 1 -,, _ del N2 5463
Locations r,�t L� 1 5
SubdivisionName Lot No. Sec. or Block No.
Lot Size House Mobile Home_ Business ''"" Speculation
No. Bedrooms v'A _ No: Baths ! No. 9n-Family ?.
Garbage r Disposal ----,.YES-,[:] NO �� � � ' ",,,Specifications for System:
Auto Dish Washer YES ❑ . NO
Auto Wash Machine YES �g NO {]
Type Water Supply _
*This permit Void if sewage system described below is not installed within436 months from date of issue.
El�
--"' 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: 704-634-5`985.
Final Installation Diagram: System Installed by S.G
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-. HE;LTH DEPARTMENT
IMPROVEMENTS PERMIT `ANDERTIFICATE OF COMPLETION
Q �- r r
i t•E l� f
;,',MTE Issued in gompliance with G.S. of North Carolina qhapter-130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC OA .1934-.1968),,. -'`Permit Number
Name Q5 E� `.�\l Date N2 0463
Location
Subdivision"' Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms _tNo.'Baths No.'in Family n�
Garbage Disposal YES:❑ NO Er''
Specifications for System:
Auto Dish Washer YES ❑ NO
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 issued
-
� i r
-- Improvements,"hermit by
'Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-
A.M.
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
Certificate of Completion -71 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.
• ' INFORMATION FOR SEPTIC SYSTEM REPAIR PERMIT
NAME ahaAl �Q�� PHONE NUMBER
ADDRESS, �, �d�L. '7'/ SUBDIVISION NAME
SUBDIVISION LOT
DIRECTIONS TO SITE & d &d;q Q d� 4 e-1
D DGZJh e) 7" D o
/G
DATE SEPTIC SYSTEM INSTALLED f97
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED, UNDER &ar-l45
SPECIFY PROBLEMS THAT ARE OCCURRING ���h /meq/jlS CQ k f�4D//e/ �')n /-�'- �usA-
DATE REQUESTED INFORMATION TAKEN BY