405 Dulin Rd DAVIE COUNTY HEALTH DEPARTMENT
T tIMPROVEMENTS PERMIT--AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
Sanitary Sewage Systems _ Permit Number
Name— nc, Date ' , "clu -'N2 6003
Location `
Subdivision Name \ Lot No. Sec. or Block No.
Lot Size 'House Mobile Home _ Busines§ Speculation
No.Bedrooms No. Baths �— No.-.,in Family -31 _
Garbage Disposal YES ❑ NO p/ Specifications for System: Z)
Auto Dish Washer. YES,Cg,/NO E] fi
Auto Wash Machine YES p,/ NO ❑ � U d 4' x
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 orthe intended use change.
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mprovements Derm t, yC\
*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,
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Final Installation Diagram: System Installed by
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Certificate of Competion 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 MEALTH DEPARTMENT
IMPROVEMENTS PERMIVAND CERTIFICATE OF COMPLETION
;KOTE.-Issued in Compliance With Article 11 of G.S.Chapter 130a
Sanitary Sewage Systems _ Permit- Number
r
Name L C_ .�\\ Date �� r C) No-
6003
Location
a_
Subdivision Name Lot No. — Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
N /�edrooms No. Baths —= No.,in Family -�
a ge Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES [IX NO ❑
Auto Wash Machine YES Z,/ NO ❑
Type Water SupplyR� _
*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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t�
' �;• —..Improvementspermit,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 1:00-4:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by
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1' 1
D
Certificate of Completion Date
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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.
WORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT d /
NAME �- PHONE NUMBER
ADDRESS SUBDIVISION NAME
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SUBDIVISION LOT#
DIRECTIONS TO SITE kzch /1. ci '�. r7-0 ' (0/
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DATE SYSTEM INSTALLED
NAME SYSTEM INSTALLED UNDER
SPECIFY PROBLEg4 OCCURRING
9,12-22t / �r A�&- gd
DATE REQUESTED "� _ 9� INFORMATION TAKEN BY