294 Houston Rd - - Vx
DAVIE COUNTY HEALTH DEPARTMENT
rt IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
•NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
Sanit/a Sewage Systems Permit Number
Name Llr f�i��d/� ; G Vii/ ` .;; .+U� _ Date '1�t �� N2 7954
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size .____— House _ y�Mobile Home ____ Business __ Industry
No. Bedrooms _.No. Baths --Z-- No. in Family __ Public Assembly Other
Garbage Disposal YES ❑ NO Ea" Specifications for System:
Auto Dish Washer YES NO ❑ _
Auto Wash Ma^hine YES NO ❑ �oo '��'iS //
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
ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT1 LAYO T BE F RE INSTALLING THIS
SYSTEM.
,d
Improvements permit by ��—
'Contact a representative of the Davie County Health Department for final inspect n of tis 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-t34_
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cle
Final Installation Diagram: System Installed y
Dr SOf
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a�
Certificate of Completion ��- -�-- Date S _
'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:Iss d in Compliance With Article I I of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Na me fir' f��?(j E _% f f '``s -�/_ Date rfN2 7954
Subdivision Name Lot No. Sec. or Block No.
Lot Size _— — House — L'"�I Mobile Home _--_ Business -- Industry
No. Bedrooms •- —.No, Baths — — No. in Family �f — Public Assembly Other
Garbage Disposal YES 0 NO p' Specifications for System:
Auto Dish Washer YES NO 0lo
4 y
Auto Wash Ma^hine YES L!1 NO ❑ � rl �� +
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
ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT1 LAYO T BE F RE INSTALLING THIS
SYSTEM.
Improvements permit by 'X
*Contact a representative of the Davie County Health Department for final inspect n of t is 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- 34-598 .
,a �
Final Installation Diagram: System Installed y — _Gs
a' SO
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i
Certificate of Completion Q _ Date 5J
'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 ENVIRONMENTAL HEALTH SECTION
i ff APPLICATION FOR IMPROVEMENT PERMIT(REPAIR)
NAME .CGt � �r %/fJO�✓ PHONE NUMBER
ADDRESS ��7 /`tBl1,17� SUBDIVISION NAME
LOT#
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY /�v � NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY—Le—SPECIFY PROBLEM OCCURRING
DATE REQUESTEDINFORMATION TAKEN BY 4e&V
This is to certify that the information provided is correct to the best of my knowledge,and that I understand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev.1193