P6571 Edgewood Cir .r. .. 1 .�, • ,t�5 t r t r ti's"".t i. .. r r- ,.., � :�i.,�r♦ .. i
DAVIE COUNTY HEALTH DEPARTMENT �xV
IMPROVEMENTS PERMIT AND..CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article li of G.S.Chapter 130a
Sanitary Sewage Systems \ Permit Number
Name Date � D -� � � NO �, f-.71
l��1 T 4 , 1 f1 y 10 I D G�`�J V Q �) I l
Location _
Subdivision Name Lot No. Sec. or Block No.
Lot Size House f/ Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal, YES.❑ NO [Er' Specifications for System:
Auto Dish Washer YES p` NO p
Auto Wash Ma,hine YES NO E] p 0%
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Type Water Supply
*This permit Void if sewage system described below is not installed withim5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change."t
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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 by
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AZ
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Certificate of Completion - Date J 5
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•The si ning of t is certificate shall indicate that the system described above has been installed in compliance with
the standards seJ forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfIctorily for ny given period of time.
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DAVIE COUNTY HEALTH DEPARTMENT '
:F . .
..iIMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION ! 3
*NOTEAssued in Compliance With Article I I of G.S.Chapter 130a
Sanitary Sewage Systems Permit. Number
@nr.S.1L Date __J-Q -,I?, J I N2
�_1 6571
Location �. nIx 7.0
Subdivision Name Lot No. Sec. or Block No
Lot Size��� House Mobile Home _ Business Speculation
No. Bedrooms -3 No. Baths - No. in Family r
Garbage Disposal YES.,❑ NO 02"'
Specifications for System: �.
Auto Dish Washer YES [2/ NO p
Auto Wash Ma,hine YES NO ❑ 0 0• u 3 i C61) .
5
Type Water Supply
�
*This permit Void if sewage system described below is not installed within5 years from date of issue.
This permit is subject to revocation if.site plans or-the intended use change.'
F
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Z' n
1
Improvements permit by
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*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 by
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`" Certificate of Completion Date
"The signing of t1is 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 Ly give6 period of time.
INFORMATION FOR SEPTIC SYSTEM REPAIR PERMIT
NAME PHONE NUMBER
ADDRESSSUBDIVISION NAME
SUBDIVISION \LOT #
DIRECTIONS TO SITE U
DATE SEPTIC SYSTEM INSTALLED
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER
SPECIFY PROBLEMS THAT ARE OCCURRING
DATE REQUESTED INFORMATION TAKEN BY �'