383 Eatons Church Rd rr DAVIE 'COUNTY HEALTH DEPARTMENT
- IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
•NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a
S nitary Sewage/Systems
�> `� ��., c)Permit Number
Name ��71v� � 3 aIGU /s �•�_dDate / Z2_1 N2 47
Location'_42j2Z_Z�Z ✓ / �r� = �Gl.i 1 hG�r:�_ u��
Subdivision Name Lot No. Sec. or Block No.
Lot Size House_ House Mobile Home Business —_ Industry
No. Bedrooms _.No. Baths —_UL— No..in Family — Public Assembly Other
Garbage Disposal YES ❑ NO ET Specifications for System:
Auto Dish Washer YES NO ❑ v07 ^/
Auto Wash Ma,:hine YES NO ❑ vd/t 3��j `�`
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
ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS
SYSTEM.
Il
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.;
1:00-1:30 P.M. or 4:30-5:00 P.M.on day of completion.Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by
T .
i
e
love
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.
l 'k .;y �� _ .r -..x}_.,,:. c.�is. � . ♦ a_'-t -' zsr - .4< _1 y.4. m. 4.._ r...:w ' '- �'`,i_. _.r a_t __ ....: , ..
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DAVIE COUNTY HEALTH, DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
•NUTE:Issued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
/.�
Name ate / N� 804
r'�r �' /�..r r_.� r" i- �_;_r t.�Dr_LAG��
Location / % ��_ Vii' r �i; /;,� �' /t�, i .. . c"
Subdivision Name Lot No. Sec. or Block No.
Lot Size /i,_' _ House — Mobile Home --- Business Industry
No. Bedrooms _ No. Baths --Le*L_ No. in Family_ ,2— Public Assembly Other
Garbage Disposal YES 0 NO al, Specifications for System:
Auto Dish Washer YES R NO 0
Auto Wash Ma^hine YES NO
Type Water Supply ,_._ I lly�e//
*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
ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEETHIS PERMIT/LAYOUT BEFORE INSTALLING THIS
SYSTEM.
t
J
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.,
1:00-1:30 P.M. or 4:30-5:00 P.M.on day of completion.Telephone Number: 704-634-5985,
Final Installation Diagram: System Installed byve
' � ..
Z
/ouLL,--,'19
r `
♦ r
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
APPLICATION FOR IMPROVEMENT PERMIT(REPAIR) qe�Q
NAME �.�a.�-'�'c. PHONE NUMBER
r
ADDRESS �� C AJJLCZ - CL . SUBDIVISION NAME
0(:,6 • LOT #
DIRECTIONS TO SITE`'. ��• �` �� II CL
. 07'
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY NUMBER BEDROOMS 9"' NUMBER PEOPLE SERVED
TYPE WATER SUPPLY /aJ-e-ep Q- SPECIFY PROBLEM OCCURRING-
sLAC
DATE REQUESTED �^ INFORMATION TAKEN BY
This Is to certify that the information provided Is correct to the best of my knowledge.rd that 1 understand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev.1/93