405 Fred Lanier Rd DAVIE COUNTY HEALTH TMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name • in. 0 S�,o v Date ` a ��Q N2 C)
Location
Subdivision Name Lot No. r Block No.
Lot Size r House Mobile Home _ Business, Speculation
No. Bedrooms 32 No Baths No,°in Family y °-
�
Garbage Disposal AYES;'[] NO 6d' ,, Specifications for System:P Y � a?iC SoIa
Auto Dish Washer`; YES ,NO E
Auto Wash Machine YES.V ,NO
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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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Impro �rh-e►�s permit by
*Contact a representative of the Davie County Health Departme t for final inspection of this system between 8:30-
9:30 A.M.Yor 1:00-1:30 P.M. on day of completion. Telephon Num er: 704-634-5985.
Final Installation Diagram: System Installed by
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v Q ertificate of Completion Date `� v
P
r i icate shall indicate that the system described above has been installed in compliance with
the standar set forth i ion, but shall in NO way be taken as a guarantee that the system will function
sati cony ony'�givel� Neriod of time
a,y x«A^.e.a ..yy+�r. -s~ :., t .fes - ♦ a �„` .: ..k; ,t t.':F..s«. ., n r � *tri ..i:l r .. _-, a .. - .Y '..,' z' '.,`. ;,::.
3►r�"`. DAVIE COUNTY HEALTH DwEPATMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*_NOTE: 'Issu-ed•in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
_Name �., �� ' �.o v Date j``1 ND {
' Location IS # � 'a �� ��� uc�., ,V �� � �U .
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Sim -y'�^J- ,.J�"�"..9�`C� 'a�°`•�..�V�" 3" �, (.�/Y1tn.-.
Subdivision Nam Lot No. $_sc-6r Block No.
Lot Size ` House Mobile Home _ Business Speculation
No. Bedrooms ? No.''Baths No. in Family }
Garbage Disposal YES 'p NO Q' Specifications for System: c`
Auto Dish Washer",, YES NO
Auto Wash Machine YES NO p
Type Water Supply \y
*This permit Void if sewage system described below is not installed-within-36.months-from.,date_of' issue.
i (,I C-
1
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1
Impo `e a is permit by 1:,."� Nrl
*Contact a representative of the Davie ColLnty Health Departure t for final inspection of this system` between 8:30-
9:30 A MAor 1:00-1:30 P.M. on day of completion. Telephon `Num er. 704-634-5985.
It Oil
Final Installation Diagram: .. System Installed by ���
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I..- TP �l�e'�
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ueI� °
/`.�� „-..Certificate of Completion Date
tgrting,�f-thts "moi icate shall indicate that the system described above has been installed in compliance with
the standards set forth i bQve-regai�;tion, but shall in NO way be taken as a guarantee that the system will function
sati n y r_any given en of time,,//
INFORMATION FOR SEPTIC.SYSTEM- REPAIR PERMIT -_
NAME PHONE NUMBER yC(�' 1
ADDRESS_ \\� `� SUBDIVISION NAME
SUBDIV`IISSION LOT # -
DIRECTIONS TO SITE Lt
DATE SEPTIC SYSTEM INSTALLED
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER
SPECIFY PROBLEMS THAT ARE OCCURRING