1817 Farmington Rd _-t a+"+a w,nu...,.-x,r J .A:(=^-y«t i'r:`-i�^� rrarf.+'r'r sr.;�l+W aim } / } r �-' �,.o. ,v;r„'.;. ..- -�..z�y-i.. .q...ri c--:•-.�F:.q::�iNv..ar'
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f DAVIE COUNTY HEALTH DEPARTMENT'
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE Issued in Compliance With Article 11 of G.S.Chapter,130a
NameA- a i ary Sqy v-age , ystem /�i/�./�� Permit Number
NVQ /YQ/ w 3 Mexanto Date Aj X9-93 N2 7335
/CJS-
Location —
Subdivision Name Lot No: Sec. or Block No.
/Y/ C
Lot.Size House Mobile Home Business Speculation
No. Bedrooms .No. Baths J No. in Family,--
Garbage
amily _Garbage Disposal YES ❑ NO 16 Specific dos or y�ym:
Auto Dish Washer YES ❑ NO 15 ��j, V
Auto Wash Ma^hive YES ❑ NO 6 ,, D
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.
1�
1
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 Instal lation.Diagram: System Installed by C� Z`_A� r
r
ertificate of Completion _4& Date /�0�� 9�
'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
Ap
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
* E ed in Compliance With Article I I of G.S.Chapter 130a
NOTE:Yssu Permit um er
a tary Sewage ystems r , �j'
y
..Name Date
�- ��•�. /r'`�yam` /�%�:/!i J/"' ✓C, d�` r� ' �`� � �,.. � G".-v ./�'`.. �, j
Location _
Subdivision Name Lot No. Sec. or Block No.
Lot Size House_ r/ Mobile Home Business _— Speculation
No. Bedrooms .No. Baths No. in Family
Garbage Disposal YES E]---NO ❑ Specific ti 'A)ot y
psi m:
Auto Dish Washer YES ❑ NO G�. ' !
Auto Wash Ma shine YES ❑ NO p
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.
,
Improverynts permit by -- —
*Contact a representative of the Davie County Health Departmentifor 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.
R
Final Installation Diagram: System Installed by
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 ENVIRONMENTAL HEALTH SECTION
WORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT
NAME 'l-ya. PHONE NUMBER
ADDRESS Pic c;?SO SUBDIVISION NAME
SUBDIVISION LOT#
DIRECTIONS TO SITE_ � �..�,��� �.�`��'� �•- �f ,d G 74e. -d"h vr.•a
DATE SYSTEM INSTALLED
NAME SYSTEM INSTALLED UNDER
SPECIFY PROBLEMS OCCURRING
DATE REQUESTED INFORMATION TAKEN BY �( a-lZ