330 Speer Rd 4 DAVIE COYWMHEALTH, DEPARTMENT
`7.
>6 IiMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name s,.l�/C' f/; iiiT�G`' /ti /�/1Gfr%r'G> Date %yr �' N2 tib 5
Location ��//l/— L�i�e - � ��
Subdivision Name Lot No. Sec. or Block No.
Lot Size House (� Mobile Home _ Business Speculation
No. Bedrooms No. Baths _r�;? _ No. in Family
Garbage Disposal YES ❑ NO [-j'' Specifications for System:
Auto Dish Washer YES NO ❑ , ,
Auto Wash Machine YES NO ❑ �� �1 V-7 /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.
-----ter
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 byC? tld!>9!J"
y� y
Lam'
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.
a, DAVIE COYNTHEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION r
.j
* ,OTE:Issued 1 , Compliance With Article 11 of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name Ue1;i��i�� J1%` lam" '� Date A�L N2 6054
Location
Subdivision Name Lot No Sec. or Block No.
Lot Size House L-� Mobile Home _ Business,", Speculation
No. Bedrooms No. Baths —�2 No. in Family
Garbage Disposal YES ❑ NO E-' Specifications for System:
Auto Dish Washer YES NO}❑ t
Auto Wash Machine YES N� ❑ �G�l~ �l/� / ' �
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.
'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 byU��
r-- 4
,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.
_ 711 /dry 97'
WORKSHEET FOR SiZPTA 'SYSTEM REPAIR PERMIT "A
NAME PHONE NUMBER A
ADDRESS ILI ox SUBDIVISION NAME
SUBDIVISION LOT#
DIRECTIONS TO SITE
z2zlo . 0 0 e e— S
DATE SYSTEM INSTALLED
NAME SYSTEM INSTALLED UNDER SfI►'� A SD���
SPECIFY PROBLEMS OCCURRING GIST. a,e�i�,r.�
2 Ea,
DATE REQUESTED �- / �n INFORMATION TAKEN BY ��