1451 Fork Bixby Rd -.,s,r_+......-r P` h t1.,V -,..-..-,- ..-.,a.z;s...6sr�'.,;::a� zs ^v`"¢�ir+nY. Y•T- o-•.r 77' .-� . �aY*..er-a'rv.+rR"'.c,'°' q}'°+Y'9""at 'rawrY+7 nwA:v,•-..,,,.,
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` DAVIE COUNTY HEALTH DEPARTMENT 'S
~ ` IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name_` 0'4EtN �O 1� Date �1 ' tel N2 6953
Location t`� �- 6-'���O 9
Subdivisi~ on Mame \� Lot No. Sec. or Block Na
Lot Size House MobiW-Home _� Business a Speculation
No. Bedrooms -3 No. Baths No. in Family
Garbage Disposal YES p: ,NO [g' Specifications for System:
Auto Dish Washer x YES p NO;(
Auto Wash Ma:hine YES NO:C] ---'
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.
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Improvements permit by0l�'
*Contact a representative of the Davie County Health Department for final `inspecUon,,of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number 704=634-5985.
System Installed b
Final Installation Diagram: Y Y--
S S
� d W
Certificate of Completion Cs 3c9-� Date ' 7
*The signing of this certificate shall indicate that the system described above has been installed infcompliance 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
" s IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'*NOTE dssuW in Compliance With Article 11 of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Mame ��� o � C.a��O ,� ~' "�` \X Date ) ! 1 `S N2 6953
LocationC
(, �I 1: � l._ \ c�•�. �- o �_�-- L� �' \� J
Subdivision Name Lot No. Sec. or Block No.
Lot Size 2 iu House t� Mobile Home Business Speculation
No.Bedrooms No. Baths No. in Family' —
Garbage Disposal YES ❑ NO p' \ Specifications for System:
Auto Dish Washer YES ❑ NO p' , I
Auto Wash Ma.hine YES E� NO ❑ � \
Type Water Supply \JJ ~ __—
*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.
( i"'
i
u
Jo o, nt a
0
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 704-634-5985.
Final Installation Diagram: System Installed b
Y—
Certificate of Completion "' -`` Date
*The signing of thid.certificate shall indicate that the systemdescribed above has been installed incompliance with
the standards set forth in the above regulation, but shall in NO way betaken as a guarantee that the system will function
satisfactorily for any given period of time.
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
WORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT
NAME c�A =�� PHONE NUMBER q
ADDRESS `�` �a N �� SUBDIVISION NAME
cs?
SUBDIVISION LOT#
DIRECTIONS TO SITE F.
DATE SYSTEM INSTALLED
NAME SYSTEM INSTALLED UNDER
SPECIFY PROBLEMS OCCURRING
DATE REQUESTED INFORMATION TAKEN BY